Contracting and Credentialing Midlevel Providers

Jan. 19, 2021

Updated 05/12/2021 — SA Modifier and Midlevel Provider Contracting Update

Blue Cross and Blue Shield of Texas (BCBSTX) directly contracts and credentials with Midlevel providers. With the upcoming 2021 implementation of the ClaimsXten edit of the SA modifier for non-payable services which will result in the SA modifier being non-reimbursable, we would like to encourage all board certified Midlevels not currently contracted with BCBSTX to consider doing so to ensure their claims are not impacted.

This direct contracting effort includes the following BCBSTX networks: Blue Choice PPOSM, Blue Advantage HMOSM, Blue EssentialsSM, Blue PremierSM, HealthSelectSM, Blue High PerformanceSM (Blue HPN)SM, Texas Medicaid, Blue Cross Medicare Advantage HMOSM, Blue Cross Medicare Advantage PPOSM and MyBlue HealthSM.

What Midlevel Specialties?
Physician Assistants must be board certified by the National Commission on Certification of Physician Assistants (NCCPA) and maintain certification for continued participation.

Nurse Practitioners must be certified by one of the following national certification boards and maintain certification for continued participation.

  • ANCC: American Nurses’ Credentialing Center subsidiary of the ANA (American Nurses’ Association). Certification through the American Nurses’ Association (ANA) must be achieved through the ANCC.
  • AANPCP: American Academy of Nurse Practitioners Certification Program
  • AACN: American Association of Critical Care Nurses
  • PNCB: Pediatric Nursing Certification Board
  • NCC: National Certification Corporation for Women’s Health (OB/GYN) Nurse Practitioners (WHNP)
  • NNP: Neonatal Nurse Practitioner (NNP) or
  • Texas Grandfather Clause: Advanced Practice Nursing educational program that was completed prior to January 1, 1996, provided the program was accredited by a National Nursing Education Accrediting Body that is recognized by the Texas Board of Nursing, may be granted an exemption to the national certification requirement. Per Title 22, Par 11, Chapter 221, Rule 221.7.

What should you do?

Midlevels can begin the process of directly contracting with BCBSTX by checking the How to Join Network Instructions.

  • Get a BCBSTX Provider Record ID and get credentialed
  • Utilize the check credentialing status option
  • Remember to Get Connected to use all available BCBSTX electronic options

We appreciate your consideration to become a directly contracted provider. Please contact your Network Management Consultant if you have further questions.