Blue Cross NC Extends Date for Mid-Level Provider Credentialing

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recently announced that nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) working with in-network groups and providing services for commercially-insured Blue Cross NC members, are now required to complete credentialing with Blue Cross NC, on or before January 1, 2017. However, due to the high response of credentialing applications already received, we are extending the deadline until March 1, 2017. This allows us time to process current applications, and manage the second wave of applications expected.

We appreciate the quick response from NPs, PAs, and CNMs initiating credentialing with Blue Cross NC. We're actively working to complete the applications we've received. If you have not yet submitted a credentialing application to Blue Cross NC, please wait to send in your applications until October 1, 2016, or later. If you have already completed your application and obtained the time-sensitive supporting documents, we will not reject your application if it is received before October 1.

Only NPs, PAs, and CNMs who are not already credentialed by Blue Cross NC are required to complete credentialing by March 1, 2017. Often, NPs, PAs, and CNMs work at more than one location, and may already be credentialed for the services they provide at another site. In these cases, if the credentialing was completed directly with Blue Cross NC, rather than a "delegated" health care system, additional credentialing may not be required.

NPs, PAs, and CNMs are only required to complete initial credentialing once with Blue Cross NC, as long as their credentialed status remains effective. Additionally, a provider's credentialed status can be applied to more than one in-network location, if the provider has been enrolled with Blue Cross NC by an additional location for their work at the location.

Please contact a Blue Cross NC Provider Network representative (formerly Network Management) with any questions about this new credentialing requirement. If you need assistance initiating the credentialing process, or you're unsure about your credentialed status with Blue Cross NC, please contact us at 1-800-777-1643.

Key Points:                    

• Any new-to-network NPs, PAs, and CNMs are required to complete credentialing with Blue Cross NC, before providing in-network services for our commercially-insured members, beginning on, and for dates after March 1, 2017.
• Blue Cross NC requests NPs, PAs, and CNMs (or their organizational credentialing departments) to initiate credentialing with us on or after October 1, 2016.
• Credentialing instructions are available on bcbsnc.com, by opening the “Become a Blue Cross NC Provider” link on the providers' home page.
• The credentialing process can take up to 60 days to complete, from the date a credentialing application is received by Blue Cross NC.
• Blue Cross NC adheres to guidelines for credentialing established by the National Committee for Quality Assurance (NCQA) and the North Carolina Department of Insurance (NCDOI).
• Following a NPs, PAs, or CNMs completion of credentialing, the credentialed provider's name and group affiliation will become eligible for display in Blue Cross NC's online provider director, Find a Doctor.
• Failure to complete credentialing by March 1, 2017, may result in a mid-level provider's inability to provide in-network services for Blue Cross NC's commercial membership.
• Blue Cross NC intends to conduct claims audits. Services determined to have been provided by a non-credentialed NP, PA, or CNM, after March 1, 2017, may be denied or adjusted, if the services were performed while working as part of, or under the supervision of a provider within an in-network health care organization.
• Blue Cross NC will revise its online provider e-manual, the Blue BookSM, to include the requirement for NPs, PAs, and CNMs to complete credentialing with Blue Cross NC in order to become eligible to perform in-network services for Blue Cross NC's commercially-insured, self-funded, and commercially-insured BlueCardSM Host membership.
• As a reminder, it's important to regularly check the provider section of bcbsnc.com for updates to the Blue Book and our online policies and procedures. These online updates are our way of providing you with electronic notice about new and amended policies and procedures.