Network Participation



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Note: Utilize the Demographic Change Form, if you already have a BCBSTX Provider Record ID and only need to update your demographics (i.e., address, phone, specialty).

Before you can join the BCBSTX Provider Networks or send claims electronically as an out-of-network provider, you will need to be assigned a BCBSTX Provider Record ID.

  • To get set up, you will need to complete the Provider Onboarding Form Learn more about third-party links For best results please utilize Google Chrome. Those providers who want to be in-network will have additional fields to complete on the form. Please refer to the Provider Onboarding Form User Guide  for tips on completing the Provider Onboarding form.

Provider Record Setup

  • Professional Providers
    • If you do not already have a Provider Record ID established with BCBSTX that matches your billing information (Rendering NPI, Billing NPI and TIN), you will need to complete the Provider Onboarding Form. For best results please utilize Google Chrome. A complete, signed and dated W9 and a copy of each provider’s license is required with all new group and solo practitioner Provider Onboarding Form submissions.
  • Group Provider Onboarding Instructions
    • Complete the Provider Onboarding Form Learn more about third-party links .using the group information. For best results please utilize Google Chrome.
    • Complete the required Provider Roster for providers that need to be affiliated with your group Tax ID and Billing NPI. (For existing groups – please only send new providers and not a full roster)
    • You must download the required Provider Roster and submit in the provided format.
    • One Tax ID per onboarding request.
  • NOTE: Submitting incorrect rosters or missing rosters may result in your application being returned

  • Hospital/Facility Based providers
    • New individual providers will need to provide the name of each Hospital or Ambulatory Surgery Center that the provider services on the comments section of the Provider Onboarding Form.
    • When adding providers to an existing contracted group/clinic - you must use the Provider Roster template entering the Hospital or Ambulatory Surgery Center in the comments section.

Note:

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

  • Obtaining a BCBSTX Provider Record ID does not automatically activate the networks. When you indicate on the Provider Onboarding Form that you want to be a participating provider you will be sent the contracts along with instructions on how to complete and submit your contract(s). Claims will be processed out-of-network, until the provider is contracted, approved and activated in the network.

  • Provider ID Requests will only be accepted via the Provider Onboarding Form. The previous paper forms will no longer be accepted. A complete, signed and dated W9 and a copy of each provider’s license is required with your Provider Onboarding application submission.


Case Status Checker
If you have completed one of the following and would like to check the status, enter the case number you received in your confirmation email in our Case Status Checker Learn more about third-party links:

  • Provider Onboarding Form
  • Demographic Update Form
  • General Email inquiries

Credentialing Status Checker
After you submit the Provider Onboarding Form to get credentialed, check the status of your credentialing process by entering your NPI or license number in our Credentialing Status Checker Learn more about third-party links.


Blue Cross and Blue Shield of TX (BCBSTX) welcomes all providers to apply for participation in the Blue Cross and Blue Shield (BCBSTX) networks. BCBSTX contracts with physicians, and other health care professional providers to form our provider networks which are essential for delivering quality, accessible and cost-effective health care services to our members.

Contracting

  • Hospital Providers: submit your information to the appropriate Network Management Office location .
  • Ancillary Providers: complete the Ancillary Provider Record Request Form  and fax to the number on the form.
  • Physicians, Professional Providers and Hospital/Facility Based Providers: complete the Provider Onboarding Form Learn more about third-party links indicating that you want to be a participating provider and you will be sent the contract(s) along with instructions on how to complete and submit your contract(s).

 

Credentialing
All providers who participate in our networks are required to complete a credentialing process prior to acceptance. See additional credentialing information below for:
         the Credentialing Process for Office Based Physicians and other Professional Providers
       or,
         the Credentialing Process for Hospital/Facility Based Providers

Note: Residency must be completed prior to being a contracted provider.


Credentialing Forms Required by BCBSTX
If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete the form, save to your computer and upload during the onboarding process that follows.

NOTE: The credentialing and network loading will be delayed or rejected for failure to attach the applicable supplemental questionnaire from the list below:

  • Behavioral Health Form - required to be submitted to BCBSTX for all Behavioral Health Providers.
  • Hospital Coverage Letter - Professional providers will either, (1) be required to have hospital privileges at an in-network hospital for each network of participation, (2) not be required to have hospital privileges at all, or (3) may be permitted to submit a signed Hospital Coverage Letter. Please refer to the list below to identify which category applies to you. Note: Professional providers who perform procedures in an acute care setting and/or ambulatory surgical setting must have privileges at an in-network facility where those procedures are performed. TX Provider Specialties/Provider Types - Hospital Privileges Requirements List  
  • Ophthalmology Treatment Expertise - Required for Ophthalmologists to indicate if their practice includes retinal surgery.

 

Other Important Information
Once you are part of our networks, we strongly encourage your participation in all electronic options available including electronic data interchange (EDI). EDI transactions help to ensure timeliness, accuracy and security of claims-related information. Please visit the Electronic Commerce section of our provider website under "Claims and Eligibility", for details on how to sign up for these electronic solutions.

We would like to provide you with more information about becoming a participating provider for BCBSTX. Please check out the following:

 


New individual providers, new medical groups, desiring to apply for network participation or existing medical groups who wish to add additional providers to your current contract, please complete the Provider Onboarding Form . A complete, signed and dated W9 and a copy of each provider’s license is required with your Provider Onboarding application submission. Please refer to the Provider Onboarding Form User Guide for tips on completing the Provider Onboarding form.


Contracting

  • Hospital  Providers:  submit your information to the appropriate Network Management Office location.
  • Ancillary Providers: complete the Ancillary Provider Record Request Form  and fax to the number on the form.
  • Physicians, Professional Providers and Hospital/Facility Based Providers: complete the Provider Onboarding Form Learn more about third-party links indicating that you want to be a participating provider and you will be sent the contract(s) along with instructions on how to complete and submit your contract(s).


Credentialing
All providers who participate in our networks are required to complete a credentialing process prior to acceptance. See additional credentialing information below for:
         the Credentialing Process for Office Based Physicians and other Professional Providers
       or,
         the Credentialing Process for Hospital/Facility Based Providers

Note: Residency must be completed prior to being a contracted provider.


Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following:

  • Right to review information submitted on or with their credentialing and recredentialing application;
  • Right to correct erroneous information;
  • Right to be informed of the status of their credentialing or recredentialing application, upon request.

Applicants should direct all requests to their Network Management Consultant. The Enterprise Credentialing Department will notify the applicant in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be granted 30 calendar days to correct erroneous and/or conflicting information and resubmit to the Enterprise Credentialing Department, your assigned Network Management Consultant or the Medical Director. It will be the applicant’s responsibility to work directly with the reporting entity to correct the erroneous and/or conflicting information.

Checking Credentialing Status

After you submit the Provider Onboarding Form to get credentialed, you can check the status by referring to the Case and Credentialing Status Checkers section above.

Types of Professional Providers Requiring Credentialing

BCBSTX requires full credentialing of the following office-based physicians and other professional providers* for participation in their managed care networks:

  • MDs and DOs
  • DDSs (oral and maxillofacial surgery)
  • Licensed Physical Therapists, Occupational Therapists
  • Optometrists, Audiologists, Speech and Language Pathologists
  • Behavioral Health Providers
  • Physician Assistants, Surgical Assistants, Advanced Practice Nurses, Certified Midwives
  • Registered Nurse First Assistants
  • Podiatrists
  • Chiropractors
  • Acupuncturists
  • Registered Dieticians

*An applicant in a training program is not eligible to be considered for network participation.


Expedited Credentialing Process

BCBSTX will provide an expedited credentialing process which allows for a "provisional network participation" status if the provider applicant:

  • has a valid BCBSTX Provider Record ID for claim payment
  • has submitted a current signed BCBSTX contract/agreement
  • completes the CAQH ProView database online application with "global" or "plan specific" authorization to BCBSTX (or if applicable, submits a completed TDI application)**
  • has a valid license in the state by, and in good standing with, the Texas Licensing Boards.

** Providers will be notified once the CAQH credentialing applications are reviewed for completeness. The review takes on average 8–10 calendar days.


Important:

  • If the applicant does not meet the "provisional network participation" requirements, the applicant must be fully credentialed and approved prior to being made effective.
  • The licensing board for Psychologists (PhDs) does not provide a quick verification method of a provider's license. PhDs will be fully credentialed and made effective after credentialing approval.
  • Credentialing is a very involved and timely process. Please allow for a sufficient period of time for the full credentialing process to be completed, before checking on status with BCBSTX. Status can be checked by referring to the Case and Credentialing Status Checkers section above.

Initial Credentialing and Recredentialing Process

Note:

In April 2018, BCBSTX began utilizing the services of Aperture® as our Centralized Verification Organization (CVO). All new and currently contracted providers with BCBSTX will begin to receive notifications from Aperture, the CVO that BCBSTX will be using. These notifications are regarding initial credentialing events and information about the new common recredentialing date that will be assigned by Aperture. Please send questions regarding the CVO to BCBSTXCredentialing_CVO@bcbstx.com.

BCBSTX requires physicians and other professional providers to use the Council for Affordable Quality Healthcare's (CAQH®*) ProView for initial credentialing and recredentialing. CAQH ProView, a free online service, allows physicians and other professional providers to fill out one application to meet the credentialing data needs of multiple organizations. The CAQH ProView database online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database. Providers will be able to utilize the CAQH ProView database at no cost.

Texas physicians and other professional providers who have a provider type listed in the CAQH Approved Provider Types list below must apply for initial or continuing participation with BCBSTX through the CAQH ProView database by accessing the CAQH website. Go to Getting Started with CAQH.


CAQH Approved Provider Types

CAQH will only accept providers who have a provider type on their approved provider types list:

CAQH Approved Provider Types

Standard Provider Types

Medical Doctor (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), Doctor of Podiatric Medicine (DPM), Doctor of Chiropractic (DC), Doctor of Osteopathy (DO)

Allied Provider Types

Acupuncturist (ACU), Alcohol/Drug Counselor (ADC), Audiologist(AUD), Biofeedback Technician (BT), Certified Registered Nurse Anesthetist (CRNA), Christian Science Practitioner (CSP), Clinical Nurse Specialist (CNS), Clinical Psychologist (CP), Clinical Social Worker (CSW), Dietician (DT), Licensed Practical Nurse (LPN ), Marriage/Family Therapist (MFT), Massage Therapist (MT ), Naturopath (ND), Neuropsychologist (NEU), Midwife (MW), Nurse Midwife (NMW), Nurse Practitioner (NP), Nutritionist (LN), Occupational Therapist (OT), Optician (OPT), Optometrist (OD), Pharmacist (PHA), Physical Therapist (PT), Physician Assistant (PA), Professional Counselor (PC), Registered Nurse (RN), Registered Nurse First Assistant (RNFA), Respiratory Therapist (RT), Speech Pathologist (SLP), Hospitalist (HOS), Advanced Practice Nurse (APN), Anesthesia Assistant (AA), Applied Behavioral Analyst (ABA), Athletic Trainers (AT), Genetic Counselor (GC ), Surgical Assistant (SA)


Exceptions:

  1. BCBSTX's requirement of use of the CAQH ProView database does not apply to physicians and other professional providers participating through delegated credentialing agreements/contracts or are solely practicing in a hospital-based environment.
  2. Texas physicians and other professional providers who do not have a provider type listed in the above CAQH Approved Provider Types list must go to the TDI website  to access and complete a Texas Standardized Credentialing Application, and fax or mail to BCBSTX the completed application along with the required supporting documents referenced below:
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Malpractice insurance face sheet
    • Summary of any pending or settled malpractice case(s) - if within 10 or less years old
    • Curriculum Vitae
    • Signed Attestation (page 18 of online application – print and sign)
    • Written Protocol (Nurse Practitioners only)

Hospital Privileges Requirements

The requirements for hospital/clinical admitting privileges are determined by the professional provider's specialty/provider type. Professional providers will either, (1) be required to have hospital privileges at an in-network hospital for each network of participation, (2) not be required to have hospital privileges at all, or (3) may be permitted to submit a signed Hospital Coverage Letter.

Please refer to the list below to identify which category applies to you.

Note: Professional providers who perform procedures in an acute care setting and/or ambulatory surgical setting, must have privileges at an in-network facility where those procedures are performed.


Additional Forms Required by BCBSTX for Credentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete the form(s) and forward to BCBSTX:


Forward completed application packet to BCBSTX:

Fax to: 972-996-8230 (preferred method)
or
Mail to:
Blue Cross and Blue Shield of Texas
Attn: Enterprise Credentialing
P.O. Box 65067
Dallas, TX 75265-0267


Aperture is a trademark of Aperture Credentialing, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. "Aperture" provides administrative services to BCBSTX. If you have any questions about the products or services offered by such vendor, you should contact the vendor directly.


CAQH Approved Provider Types

CAQH will only accept providers who have a provider type on their approved provider types list:

CAQH Approved Provider Types

Standard Provider Types

Medical Doctor (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), Doctor of Podiatric Medicine (DPM), Doctor of Chiropractic (DC), Doctor of Osteopathy (DO)

Allied Provider Types

Acupuncturist (ACU), Audiologist (AUD), Biofeedback Technician (BT), Alcohol/Drug Counselor (ADC), Christian Science Practitioner (CSP), Clinical Nurse Specialist (CNS), Clinical Psychologist (CP), Clinical Social Worker (CSW), Professional Counselor (PC), Licensed Practical Nurse (LPN), Massage Therapist (MT), Marriage/Family Therapist (MFT), Naturopath (ND), Neuropsychologist (NEU), Midwife (MW), Nurse Midwife (NMW), Nurse Practitioner (NP), Nutritionist (LN), Occupational Therapist (OT), Optometrist (OD), Optician (DT), Physical Therapist (PT), Registered Dietician (RD), Registered Nurse (RN), Certified Registered Nurse Anesthetist (CRNA), Registered Nurse First Assistant (RNFA), Respiratory Therapist (RT), Speech Pathologist (SLP)

 

Important:

Providers who have a Provider Type listed in the CAQH Approved Provider Types list above:


Providers who do not have a Provider Type listed in the CAQH Approved Provider Types list above:

  1. Visit the TDI website  to access a Texas Standardized Credentialing Application.
  2. After completing the application, please gather the following required supporting documents:
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Malpractice insurance face sheet
    • Summary of any pending or settled malpractice case(s) — if within 10 or less years old
    • Curriculum Vitae
    • Signed Attestation (page 18 of online application — print and sign)
    • Written Protocol (Nurse Practitioners only)
  3. Additional Forms Required by BCBSTX for Credentialing
    If you are a physician or other professional provider, review the following list for any additional forms applicable to your facility. Complete necessary forms and include them in your collection of credentialing documents to be mailed to BCBSTX:

  4. Forward completed credentialing application packet to BCBSTX:

    • Fax 972-996-8230 (preferred method)
    • OR
    • Mail
      Blue Cross and Blue Shield of Texas
      Attn: Enterprise Credentialing
      P.O. Box 65067
      Dallas, TX 75265-0267

Create and/or update CAQH ProView Profile

Physicians and other professional providers must have a CAQH Provider ID to register and begin the credentialing process.

First Time Users (If you are not registered with CAQH)

  1. Get started by going to CAQH ProView to create your profile
  2. Once you obtain a BCBSTX Provider Record ID and submit a current signed BCBSTX contract/agreement to BCBSTX, BCBSTX will add your name to its roster with CAQH.
  3. Physicians and other professional providers who do not have internet access may submit their application via fax to CAQH by first contacting the CAQH Help Desk at 888-599-1771.

Note: Registration and completion of the online application is free.


Existing Users

  1. If you have already registered your CAQH Provider ID then complete or update the online credentialing application.

Completing the Application Process

The CAQH ProView standardized application is a single, standard online form that meets the needs of all participating health care organizations. When completing the application, you will need to indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the ProView service is maintained by CAQH in a secure, state-of-the-art data center.

Reference Materials for Completing the UPD Online Application

  • Previously completed credentialing application
  • List of previous and current practice locations
  • Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc)
  • State medical license(s)
  • Drug Enforcement Administration (DEA) Certificate
  • IRS Form W-9(s)
  • Malpractice insurance face sheet
  • Summary of any pending or settled malpractice cases – if within 10 or less years old
  • Curriculum Vitae

Note: When you are ready to begin entering your data, log into the CAQH ProView  database with your user name and password.

After completing the online credentialing application, you will also be asked to:

  • Authorize access to your information — Check the box beside BCBSTX, or you may select "global authorization."
  • Verify your data entry/Attest — Review the summary of your data for accuracy and completeness, and make any necessary changes.
  • Submit supporting documents — Fax the applicable documents required to complete your application to CAQH at 866-293-0414.
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Malpractice insurance face sheet
    • Summary of any pending or settled malpractice case(s) (if within 10 or less years old)
    • Curriculum Vitae
    • Signed Attestation (page 18 of online application – print and sign)
    • Written Protocol (Nurse Practitioners only)

If you have any questions on accessing the CAQH ProView database , you may contact the CAQH Help Desk at 888-599-1771 for assistance.

Note: BCBSTX may contact you to supplement, clarify or confirm certain responses on your application. Therefore, you may be required to submit additional documentation in some situations, in addition to the information you submit through the CAQH ProView database.

Additional Resources

Explore the CAQH ProView website  for more information about the CAQH ProView database and the application process. Or you can view the CAQH Provider Credentialing Application  now.

View the CAQH Provider and Practice Administrator Quick Reference Guide 


CAQH Contact Information
Help Desk 888-599-1771
Online Application System 
Help Desk Email Address caqh.uphelp@acsgs.com

6 a.m. – 8 p.m., CT, Monday – Thursday
6 a.m. – 6 p.m., CT, Friday
Fax Supporting
Documentation to:
866-293-0414



The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation's leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs.

CAQH is solely responsible for its products and services, including the CAQH ProVIew.


For your convenience, we have outlined the information necessary for Hospital/Facility Based providers to become a BCBSTX contracting provider. Eligible specialties include, but are not limited to, Anesthesia, Emergency Medicine, Hospitalist, Neonatology, Pathology and Radiology.

Hospital or Facility Based Providers must have the following:
  • Hospital or Ambulatory Surgical Center privileges
  • 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)

Upon receipt of the Provider Onboarding Form, you will be sent the contracts for which you are eligible to participate along with instructions on how to complete and submit your signed contract(s). If you did not provide the name of each Hospital or Ambulatory Surgery Center that the provider services on the Provider Onboarding Form, you will need to submit this information for each provider with your signed contracts.

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 the network.

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


Keeping your information current with CAQH and BCBSTX is your responsibility.

CAQH ProView Database
You will be sent automatic reminders from CAQH to review and attest to the accuracy of your data. Use the CAQH ProView database  to report any changes to your practice.

Note: You must enter your changes into the CAQH ProView database for BCBSTX to access during the credentialing and recredentialing process. Only health plans that participate in the CAQH ProView database that you have authorized access will receive any changes.

BCBSTX Provider File Updates
BCBSTX members rely on the accuracy of the provider information in our online Provider Finder®. This is why it’s very important that you also inform BCBSTX of changes to your practice. If you are a participating provider with BCBSTX, you may request most changes online by using the online Demographic Change Form.


The process of recredentialing is identical to that for credentialing, and is consistent with NCQA and State of Texas requirements.

  • If you are an existing user of CAQH, you are required to review and attest to your data once every four (4) months.
  • At the time you are scheduled for recredentialing, BCBSTX will send your name, via its roster, to CAQH to determine if you have already completed the CAQH ProView credentialing process and authorized BCBSTX or selected “global authorization”. If so, BCBSTX will be able to obtain current information from the CAQH ProView database and complete the recredentialing process without having to contact you.
  • If your credentialing application (for recredentialing) is not available to BCBSTX through CAQH because
    1. you have not completed the CAQH ProView credentialing process - CAQH will mail you a welcome kit that includes access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the CAQH ProView database via the Internet to complete and submit your application,
    2. or
    3. you are a physician or other professional provider who does not have a provider type listed in the CAQH Approved Provider Types list, you must go to the TDI website  to access and complete a Texas Standardized Credentialing Application, and fax or mail the completed application along with the required supporting documents referenced below:
      • State medical license(s)
      • Drug Enforcement Administration (DEA) Certificate
      • Malpractice insurance face sheet
      • Summary of any pending or settled malpractice case(s) - if within 10 or less years old
      • Curriculum Vitae
      • Signed Attestation (page 18 of online application – print and sign)
      • Written Protocol (Nurse Practitioners only)
  • Forward completed application packet to BCBSTX:

    Fax to: 972-996-8230 (preferred method)
    or
    Mail to:
    Blue Cross and Blue Shield of Texas
    Attn: Provider Administration
    P.O. Box 65067
    Dallas, TX 75265-0267

Note: Recredentialing Decision Notification – Upon completion of the recredentialing process, providers are considered approved unless notified otherwise. Notifications of the determinations other than approval will be mailed within 10 business days of the decision.

Additional Forms Required by BCBSTX for Recredentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete and forward by fax or mail to BCBSTX as indicated above.