Join the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provider network or recredential today.
Choose the process you'd like to start:
Becoming an in-network Blue Cross NC provider is a simple three-part process.
- Get credentialed or recredentialed
- Register your National Provider Identifier (NPI) with us
- Have a signed contract
Existing providers will need to be recredentialed every three years with Blue Cross NC.
Network Exceptions:
- Optometry and Ophthalmology commercial networks are closed in all counties. Optometrist and ophthalmologist participation for routine vision is managed by Community Eye Care (CEC). Contact CEC for participation inquiries and to initiate credentialing and/or recredentialing by email at providers@cecvision.com and by phone. (CEC 888-254-4290)
- Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.
Credentialing/Recredentialing Updates:
Effective Oct. 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin using Verifide, a credentialing verification organization, to conduct primary source verification. Here’s what this means for you:
- Verifide uses the CAQH ProView credentialing database as part of their verification process. Therefore, all providers applying for Blue Cross NC credentialing and recredentialing must be registered in CAQH ProView.
- If you are not registered for CAQH ProView and are seeking credentialing/recredentialing, please visit https://proview.caqh.org and click "register now" in option 3 under the "FIRST TIME HERE?" section. If you have trouble registering, contact CAQH ProView at: 1-888-599-1771, M-F 7 a.m. – 8 p.m. (EST) or use the chat portal on the website. You also should complete your profile and attestation once you're registered.
- If you are already registered for CAQH ProView, you do not need to take any action. Verifide will contact you if they need additional or updated information for primary source verification. Additionally, you should continue your usual process of attesting every 120 days that your information is accurate in the CAQH ProView database.
- Recredentialing will be delayed until provider information is complete and updated in the CAQH ProView database.
If you have questions, contact Provider Services at 1-800-777-1643 option 6.
Additional Information
Guidelines
Blue Cross NC follows the rules set up by the National Committee for Quality Assurance (NCQA) and the North Carolina Department of Insurance (NCDOI). NCQA is responsible for accrediting Managed Care Organizations (MCO's) using set standards for Credentialing, Quality Management, Utilization Management, Member Rights and Responsibilities, Preventive Health, and Medical Records. The NCDOI is the regulatory body for the state of North Carolina for managed care organizations.
Practitioner Rights
Each provider applying for credentialing and/or recredentialing with Blue Cross NC has the right to:
- Fix any errors
- Review information sent to support credentialing application
- Ask for information about credentialing and/or recredentialing application status
- Be informed of these rights
You don't need to be credentialed to register your NPI number. But we suggest you complete both steps at the same time.
Are you interested in being an out-of-network provider? You only need to register your NPI number.
Out-of-Network Provider NPI Registration
Use these forms to register your NPI number and Tax ID with Blue Cross NC. We've also included instructions to help you complete the forms if you need additional help.
For Individual Providers
For Group Providers
Email us your enrollment application and Taxpayer ID form:
Fax
919-765-4349
Mailing address
Blue Cross and Blue Shield of North Carolina
Attention: PrIMO
P.O. Box 2291
Durham, NC 27702-2291
Apply for Credentialing or Recredentialing
All providers in the Blue Cross NC network need to be recredentialed every three years. You can use the online application process to send your application documents to us.
Who's required to be credentialed/recredentialed?
Providers
Board Certified & Non-Board Certified:
- Doctor of Dental Surgery
- Doctor of Maxillofacial Surgery
- Doctor of Medical Dentistry
- Doctor of Osteopathy
- Doctor of Podiatry
- Medical Doctor
Other:
- Advanced Practice Nurse
- Audiologist
- Certified Substance Abuse Counselor
- Chiropractor
- Doctor of Dental Science
- Doctor of Optometry
- Hearing Aid Fitter
- Licensed Certified Social Worker
- Licensed Clinical Addiction Specialist
- Licensed Clinical Social Worker Associate
- Licensed Dietitian Nutritionist
- Licensed Marriage and Family Therapist
- Licensed Marriage and Family Therapist Associates
- Licensed Pastoral Counselor
- Licensed Professional Counselor
- Licensed Professional Counselor Associate
- Licensed Psychological Associate
- Occupational Therapist
- Pharmacist
- Physical Therapist
- Physician Assistant
- Psychiatric Nurse
- Psychologist
- Respiratory Therapist
- Speech Pathologist
Facilities
- Ambulance
- Ambulatory Surgical Center
- Birthing Center
- Independent Diagnostic Testing Facility
- Dialysis Facility
- Durable Medical Equipment (Diabetic Supplies Only)
- Free Standing Radiology
- Home Durable Medical Equipment
- Home Health Agency
- Home Infusion Therapy
- Hospice Agency
- Hospital
- Intensive Outpatient Facility
- Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)
- Opioid Treatment Centers
- Orthotics and Prosthetics
- Partial Hospitalization
- Private Duty Nursing
- Reference Laboratory
- Residential Treatment Facility
- Skilled Nursing Facility
- Sleep Center
- Specialty Pharmacy
Begin the credentialing/recredentialing process.
Fields marked with an asterisk (*) are required.
Join our Provider Network
Who's required to be credentialed/recredentialed?
Providers
Board Certified & Non-Board Certified:
- Doctor of Dental Surgery
- Doctor of Maxillofacial Surgery
- Doctor of Medical Dentistry
- Doctor of Osteopathy
- Doctor of Podiatry
- Medical Doctor
Other:
- Advanced Practice Nurse
- Audiologist
- Certified Substance Abuse Counselor
- Chiropractor
- Doctor of Dental Science
- Doctor of Optometry
- Hearing Aid Fitter
- Licensed Certified Social Worker
- Licensed Clinical Addiction Specialist
- Licensed Clinical Social Worker Associate
- Licensed Dietitian Nutritionist
- Licensed Marriage and Family Therapist
- Licensed Marriage and Family Therapist Associates
- Licensed Pastoral Counselor
- Licensed Professional Counselor
- Licensed Professional Counselor Associate
- Licensed Psychological Associate
- Occupational Therapist
- Pharmacist
- Physical Therapist
- Physician Assistant
- Psychiatric Nurse
- Psychologist
- Respiratory Therapist
- Speech Pathologist
Facilities
- Ambulance
- Ambulatory Surgical Center
- Birthing Center
- Independent Diagnostic Testing Facility
- Dialysis Facility
- Durable Medical Equipment (Diabetic Supplies Only)
- Free Standing Radiology
- Home Durable Medical Equipment
- Home Health Agency
- Home Infusion Therapy
- Hospice Agency
- Hospital
- Intensive Outpatient Facility
- Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)
- Opioid Treatment Centers
- Orthotics and Prosthetics
- Partial Hospitalization
- Private Duty Nursing
- Reference Laboratory
- Residential Treatment Facility
- Skilled Nursing Facility
- Sleep Center
- Specialty Pharmacy
Begin your application to join our provider network.
Fields marked with an asterisk (*) are required.