Becoming credentialed by Blue Cross Blue Shield (BCBS) is a milestone for most healthcare providers. It enables you to see more patients, gain trust, and increase revenue. BCBS boasts one of the largest networks in the US, and being part of this network opens the door to millions of covered patients. For most providers, however, the credentialing process is either unknown or takes too long. The good news is that if you do it the right way, you will be able to finish it quickly and easily.
In this tutorial, we will walk you through how to get your BCBS credentialing completed in simple steps, what you will need, and how medical billing professionals can help you along the way.
What is BCBS Provider Credentialing?
BCBS provider credentialing is the process that verifies your professional credentials services and background before your entry into the BCBS network. The idea is to make sure all professionals in the medical field are of the same high-quality level required by Blue Cross Blue Shield.
The following is reviewed by BCBS during credentialing:
- Medical license and certifications
- Education and training background
- Work experience and hospital affiliations
- Malpractice insurance and claim history
- NPI (National Provider Identifier) number
Once you have completed the verification, you will be a BCBS-approved provider and can see BCBS-insured patients and get paid by their insurance plans in exchange for your service.
Get Your Documents in Order
Before you start the BCBS credentialing process, get all your documents in order. Missing information can hold up your application, so it is worth it to be organized. Make sure you have:
- A valid state medical license
- Verification of education and training
- Board certificates (as required)
- Active malpractice coverage
- Updated CV and work history
- Tax ID and NPI number
Keep electronic and printed copies handy. Being ready beforehand helps you complete your application without interruption.
Complete the BCBS Provider Application
Visit the Blue Cross Blue Shield provider portal for your state. Every state has its own BCBS division, and their websites may look slightly different. You’ll find an online provider application form that must be filled out completely.
Enter all information carefully and review it twice for inaccuracies. One small error, such as incorrect address or old license number, will delay approval. Be honest and define your experience accurately because BCBS will authenticate everything.
Update Your CAQH Profile
Most BCBS plans credential through the CAQH ProView system. It’s an Internet-based system where providers can update their professional information in one location. BCBS can simply pull your information from CAQH in order to credential you.
Keep your CAQH profile active, current, and complete. Complete all additional documentation and update your attestation every 120 days. BCBS is unable to process your application if your CAQH profile is not active or complete.
Respond Promptly to BCBS Requests
After submitting your application, the BCBS credentialing staff will process your information. They will call or email you as well in case they need more information or clarification. Respond right away. Not responding will hold up your approval.
Monitor your email and BCBS provider portal regularly for update. If you move or change, notify your contact information right away.
Verification and Approval
When all of your paperwork comes in, BCBS conducts primary source verification. That is the process of verifying your licenses, certifications, and employment history directly with the institutions that issued them.
It may take several weeks, depending on how promptly those institutions respond. If everything checks out, BCBS will approve your application and issue a provider identification number (PIN).
This code allows you to submit claims, check eligibility, and receive payment for BCBS-covered services.
Start Accepting BCBS Patients
Congratulations, you’ve been approved. You’re now a BCBS network provider. You can now treat patients with BCBS insurance and directly bill the insurance company for your services.
Make sure to review the BCBS provider manual for your state. It contains billing procedures, payment procedures, and claim submission deadlines. Knowing these rules will prevent errors and claim denials.
How Medical Billing Services Can Assist You
Having a professional medical biller perform your credentialing and billing may make the process easier. These professionals handle all the paperwork, follow up with BCBS, and ensure that your application is complete and accurate.
Once approved, online medical billing services allow you to successfully process claims. They track every submission, conduct insurance follow-ups, and reduce denied claims. Consequently, you get paid sooner and enjoy a steady cash flow.
Aside from that, denial management services help to identify the cause of a claim denial and address those problems in a timely manner. That constant support keeps your revenue cycle in great condition and minimizes the disruptions.
The Need for Medical Coding Audit Services
After credentialing, compliance is just as important as securing approval. Medical coding audit services make your coding correct, up-to-date, and compliant with BCBS guidelines.
Incorrect coding can lead to claims denials, delayed payment, or even an audit. Regular coding audits will make your billing compliant and revenue stable. The audits also train your staff to avoid repeated errors.
Common Errors to Steer Clear of
- Incomplete Applications – Complete all fields.
- Old CAQH Profiles – Update your profile to avoid delays.
- Ignoring Emails from BCBS – Timely responses keep your process flowing.
- Missing Documentation – Have all documentation handy and in order.
- Incorrect Billing After Approval – Familiarize yourself with BCBS billing policies prior to submitting claims.
Skipping these frequent errors will enable you to become credentialed more quickly and serve BCBS patients without any hindrance.
Benefits of BCBS Credentialing
BCBS Credentialed provides the following benefits:
- Access to a vast network of patients
- Increased reputation and credibility
- Constant source of insurance reimbursements
- Referral partnership relationships
- Quick long-term financial growth
Being part of the BCBS network, besides adding to your professional credibility, makes your practice expand.
Last Words
Blue Cross Blue Shield certification is a strategic step in furthering your medical practice growth or health career. Although it is not an easy process, the secret lies in careful planning, effective documentation, and prompt communication.
Having a partner with an established medical billing company gives you added support — from credentialing to claims submission. These experts are able to handle your online medical billing, denial management services, and medical coding audit services so you can focus on what matters most: providing quality care to your patients.
