BCBS Provider Enrollment: What To Expect

The challenge of meeting each payer’s unique provider credentialing and enrollment processes can be daunting. As a healthcare credentialer, you know the importance of working with insurance payers to ensure smooth and timely reimbursement. So understanding their processes is a must.

Blue Cross Blue Shield (BCBS) is unique because it comprises independent companies with different enrollment requirements. To simplify things, we’ll walk you through the general steps on how credentialers can enroll providers with most BCBS companies, the information and documents you’ll need, and the best practices to follow. To ensure credentialers submit accurate information, visit the BCBS company website where you’re enrolling.

Why Is Payer Enrollment Important For Healthcare Organizations?

Payer enrollment is a crucial step that allows your healthcare providers to participate in the network of a specific insurance payer. By enrolling with individual payers, your organization gains access to a wide range of patients with insurance coverage. In addition, being in-network with specific payers means your facility can provide healthcare services to its members at negotiated rates, leading to more stable revenue streams and better financial stability.

Benefits of Enrolling Your Providers With BCBS

Here are some key advantages of your organization enrolling providers with BCBS:

• Expanded Revenue Opportunities: BCBS companies make up five of the top 10 largest insurers in the U.S. Your organization will have access to nearly 3 million members across 14 states.
• Competitive Reimbursement Rates: BCBS companies offer competitive reimbursement rates to in-network providers. Your organization will receive fair compensation for your providers’ services, contributing to organizational revenue growth and stability.
• Patient Trust and Confidence: Being in-network with a reputable insurance payer like BCBS can instill trust and confidence in the patients seen by your providers. BCBS members are more likely to choose providers within their network, and by being part of that network, your organization can attract and retain more patients – and providers – and the revenue that comes with them.
• Collaboration and Referrals: Enrolling your providers with BCBS opens up opportunities for collaboration and referrals with other BCBS companies. This can lead to mutually beneficial relationships and help grow your organization’s professional network.

By enrolling with BCBS companies, you can tap into these benefits and position your practice for long-term success.

Understanding The Payer Enrollment Process

Before enrolling healthcare providers with Blue Cross Blue Shield, it’s essential to have a clear understanding of the payer enrollment process. Here are the key steps:

1. Gather Training and Education
2. Gather Licensing and Certification
3. Gather Work History Details
4. Gather Payer-Specific Requirements
5. Following Application Submission

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BCBS Provider Enrollment Guidelines

BCBS requires that all providers meet standard credentialing criteria to become a healthcare professional in its network. Recredentialing is required every three years in most states. The recredentialing process requires meeting the same criteria as during the initial credentialing process. BCBS uses the Council for Affordable Quality Healthcare (CAQH credentialing) ProView application for credentialing. 

Here is a list of required information for BCBS credentialing:

• Your signature and application date
• CAQH status of “Initial Application Complete” or “Reattestation”
• Current license to practice in each state where services are provided
• Education/Training to support requested specialty(ies) (or documentation that provider will complete training within 60 days of application)
• Current hospital privilege information
• Current DEA or CDS certificate in each state where services are provided
• Explanations to questions on the application
• Five years of work history, in month/year format
• Current professional liability insurance
• Applicant must also allow a site review within 30 days of our request, if applicable

The credentialing process typically takes 45 days from the BCBS Credentialing Department receiving each provider’s completed CAQH application.

Enroll Successfully The FIRST Time

MedTrainer Credentialing Software keeps all the necessary information for BCBS provider enrollment in one user-friendly place with proven workflows, customizable dashboards, one-click reporting, and automated reminders to keep tasks on track.

Our powerful software offers:

• Enrollment Applications Dashboard: Quickly assess and improve your enrollment process with dynamic graphs that show application age, average time to complete applications, and number of closed applications per credentialer. 
• Built-in Automation: Keep the enrollment process moving forward with automated reminders for providers to send documents, notification of recredentialing deadlines, and license expiration. 
• Highly Customizable Reports: With all credentialing data in one place, it is easy to customize reports for monthly payer submissions so that you can stay on top of due dates and status. Save reports for easy access, and schedule them to be emailed to internal and external recipients. 
• CAQH Profile Management: Streamline your enrollment processes with the most up-to-date provider information at your fingertips. Save time and improve provider onboarding and recredentialing with CAQH profile management. 
• Application Workflow Management: Simplify enrollment processing with a customized workflow, status, process checklist, notes, and task assignments. Easily assign multiple enrollments to staff, update statuses, and prioritize. 

Download our guide – Tools to Conquer Provider Enrollment – for valuable tips on speeding up the time from credentialing to enrollment approval. Schedule your demo to see MedTrainer Credentialing Software in action.