Credentialing and Contracting Process for Ancillary Providers

Step 1: Provider Record ID Set up

You cannot complete credentialing and contracting process below until you have been assigned a provider record ID. Complete the Ancillary Provider Record Request Form and email to the address on the form along with the supporting documents indicated on the form.

Step 2: Complete the Provider Questionnaire and Ancillary Checklist

Once you have an established provider record ID, complete the Credentialing/Recredentialing Ancillary/Hospital Provider Questionnaire.

You must include the appropriate information indicated on the Ancillary Credentialing Checklists section below. The Credentialing/Recredentialing Ancillary/Hospital Provider Questionnaire and any additional information required should be sent to the appropriate email address as indicated below by specialty.

Ancillary Credentialing Checklists:

Submit the following with the Provider Questionnaire to :

Submit the following with the Provider Questionnaire to :

Submit the following with the Provider Questionnaire to :

Submit the following with the Provider Questionnaire to :

When your information is received you will be assigned a case number. Cases are worked in the order they are received. This process can take up to 90 days to complete.


  • Incomplete or duplicate applications could result in a delay.
  • Completion of the credentialing forms in no way guarantees BCBSTX acceptance into any BCBSTX Managed Care, Medicaid, Medicare Advantage or VA networks. Provider will be notified by letter when credentialing is approved.

Step 3: Get Contracted

To participate in the BCBSTX network(s), once the provider receives confirmation that credentialing is approved, the provider should contact the Ancillary Contracting mailbox listed above by specialty to initiate the contracting process.