Verification Process for Facility (Hospital) Based Providers

Note: Under the Consolidated Appropriations Act (CAA), all contracted providers must be listed in the provider directory. If you previously chose not to be listed in Provider Finder, your directory information must be displayed starting in February 2022. Directory information includes name, location and hours, contact information, specialties, languages spoken, credentials, affiliations and whether you are accepting new patients. The address you’ve provided to us will be displayed.

Facility Based Providers are those who practice primarily in at least one of the Facility types in the grid below. All Facility affiliations must be listed on the Provider Onboarding Form.

Note: Facility Based Providers practicing in a Free Standing Emergency Room (FSER) or Skilled Nursing Facility (SNF)I, who have current credentialing through an In-Network BCBSTX Facility Type listed above, do not require direct credentialing through BCBSTX.

Providers who only provide services at an FSER/SNF and who do not have current credentialing through an In-Network BCBSTX Facility Type listed above, will require direct credentialing through BCBSTX.

We have outlined the required information for Facility Based Providers to become a BCBSTX contracted provider:

Step 1: Review Requirements

Facility Based Providers must have the following:

• Current credentialing through a BCBSTX In-Network Facility Type listed above
• Type 1 NPI #
• Texas State Board of Medical Examiners license (temporary permit is acceptable) or appropriate Texas licensure
• Provider must be physically located in the state of Texas
• Certificate/AANA# (applicable to CRNA providers only)
• NCCAA certificate (applicable to Anesthesia Assistants providers only)

Step 2: Complete the Provider Onboarding Form

Refer to the Provider Onboarding Process to obtain a Provider Record ID and request to participate In-Network. When completing the form or roster:

• Ensure all provider information is included on the Provider Onboarding Form and roster. Completing this information accurately, in its entirety, will prevent delays in processing. Examples: name, date of birth, NPI, social security number, gender, tax ID, etc.
• Group onboarding providers need to include the name of all facilities where they practice. This must be included in the “Hospital/Facility Name or NPI” column of the Provider Onboarding Roster.
• Solo providers need to include the name of the facility where they practice. This must be included in the “Hospital/ASC Name” section of the Provider Enrollment Form.

For new groups and individual providers, upon receipt of the fully completed Provider Onboarding Form, and roster (for group providers), you will be sent the contracts for networks which you are eligible to participate in, along with instructions on how to complete and submit your signed contract(s). Providers will be processed upon receipt of the signed contracts.

Additional providers being added to previously contracted groups will be processed from the roster information.

Status Checker

If you have completed a Provider Onboarding Form, you can check the status by referring to the Case and Credentialing Status Checkers.

Note: A BCBSTX Provider Record ID does not automatically activate the networks. Claims will be processed out-of-network, until the provider has applied for network participation, been approved, and activated In-Network.