Blue Cross Blue Shield credentialing: how to join your state's Blue plan

Which Blue plan is yours?

Each Blue company runs its own credentialing, contracts and fee schedules. Applying to the wrong one is a common first mistake, especially with names like "Anthem Blue Cross" in one state and "Blue Cross and Blue Shield" in the next. Some of the larger ones:

Some states have more than one Blue plan, split by region. Pennsylvania and New York are examples. Go by the plan that covers the county where your office is.

How BlueCard lets you see out-of-state Blue members

You don't need a contract with every Blue plan in the country. Under the BlueCard program, when a member of another state's Blue plan visits you, you treat them as you would your local members and send the claim to your local Blue plan. Your local plan handles payment and questions, and works with the member's home plan behind the scenes.

You can spot these patients by the three-character prefix at the start of their member ID and the suitcase logo on their card. A few products follow their own rules, such as the Federal Employee Program and some dental, vision and pharmacy benefits, so check with your local plan if a card looks different.

Join the right networks, not just the plan

One Blue plan usually runs several networks: commercial PPO, HMO or "Blue Choice" style networks, ACA marketplace plans, Medicare Advantage and, in many states, Medicaid managed care. Being credentialed with the plan doesn't put you in all of them. Ask which networks your contract covers, and request the ones your patients are actually in. A practice that sees older patients, for example, will want the plan's Medicare Advantage network as well as its PPO. That network is separate from traditional Medicare, which you join through Medicare enrollment in PECOS.

How to apply, step by step

Step 1: Check the network is open

Before you apply, ask the plan's provider network team whether your specialty is open in your county. Blue plans close panels in some areas when they have enough providers. If it's closed, ask what exceptions apply (below).

Step 2: Get your CAQH profile ready

Blue plans read most of your information from CAQH, as do most other insurers in the insurance credentialing process. Make sure the profile is complete, attested in the last 120 days, and authorizes this Blue plan to view it. Our CAQH guide covers each step.

Step 3: Submit the request

Start from your plan's "join our network" or provider enrollment page. Many Blue plans take requests through Availity, the provider portal they share with other insurers. Others use their own form. Have your NPI, Tax ID, CAQH ID, practice locations and the networks you want ready. If you'll bill under a group, apply with the group's Tax ID and NPI so you're linked to it from the start.

Step 4: Credentialing and contracting

The plan verifies your license, education, malpractice history and sanctions, then a credentialing committee approves you. Contracting runs alongside or after: you'll get a participation agreement with a fee schedule for each network. Read it before signing, especially which networks and locations it lists.

Step 5: Get your effective date

Don't bill Blue patients as in-network until you have your effective date in writing. Then check the plan's online provider directory a few weeks later to make sure you appear in every network and location you signed for.

How long BCBS credentialing takes

Expect roughly 60 to 120 days from a complete application, sometimes longer for busy plans or when contracting needs extra steps. The biggest delays are an unattested or unauthorized CAQH profile, missing documents, and applications sent to the wrong Blue company. A call every one to two weeks, with the reference number at hand, keeps things moving.

If the Blue network is closed

Ask whether the closure covers your exact specialty and county, and whether the plan makes exceptions: an area short of providers, languages you speak, evening or weekend hours, or a sub-specialty it lacks. Make the case in writing. If it stays closed, ask to join the waitlist and when the network will be reviewed again. Meanwhile, you can still see Blue members out-of-network if their plan allows it.

Common mistakes

• Applying to the wrong Blue company, or to a neighboring state's plan.
• CAQH not authorized for the Blue plan, or the attestation has lapsed.
• Joining only one network and later finding your patients are in another.
• Individual and group mix-ups: credentialed under your own Tax ID when you bill under the group's.
• Mismatched addresses between NPPES, CAQH and the application.
• Letting re-credentialing lapse later on. Blue plans re-credential about every three years, and a lapse can mean reapplying to a closed network. See recredentialing and revalidation.

Common questions