Manual Application for Facilities Credentialing

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Facilities

Becoming an in-network Blue Cross NC facility is a three-part process. 

First, you'll need to fill out and send us the Blue Cross NC Facilities Provider Application for Participation form. You'll also need to send us all required documents with your application at that time. Finally, you'll need to register your NPI number. 

Still have some questions? View our FAQ.

 

Part 1

First download your application

Download Facility Application

Email
credentialing@bcbsnc.com

Fax
(919) 765-7016

Mail
Blue Cross and Blue Shield of North Carolina
Attn: Credentialing Department
P. O. Box 2291
Durham, NC 27702

 

Part 2

Select your facility type below to see requirements for your facility

 

Ambulance

Please include the following documents with your application:

  • A copy of a NC license

  • Proof of Medicare certification

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites
     

 

Ambulatory Infusion Centers

Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS) – we will accept a site survey conducted within the past 3 years. 

Please include the cover letter and follow-up letter (if applicable):

  • One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • The Community Accreditation Program, Inc. (CHAP)

    • Accreditation Commission for Health Care (ACHC)

  • Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.

    • Note: A current one page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.

  • On the application form, if the facility answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:

    • Number of cases less than $200,000

    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
       

 

Ambulatory Surgical Center

Please include the following documents with your application:

  • Ambulatory Surgical Centers must be accredited. One of the following accreditation certificates is required:

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • The Community Accreditation Program, Inc. (CHAP)

    • Accreditation Commission for Health Care (ACHC)

    • Accreditation Association for Ambulatory Health Care, Inc. (AAAHC)

    • American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)

  • A copy of the Division of Facility Services License is required for each site (or letter attesting to all covered sites). Medicare/Medicaid verification is needed for each site (or letter attesting to all covered sites) if applicable.

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.

  • A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.

 

 

Birthing Center (Blue Cross NC Only)

Please include the following documents with your application:

  • Birthing Centers must be accredited. One of the following accreditation certificates is needed:

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • Accreditation Association for Ambulatory Health Care, Inc. (AAAHC)

    • Critical Access Certification for hospitals

    • Commission for the Accreditation of Birth Centers

  • A copy of the Division of Health Services regulation license is required for each site (or letter attesting to all covered sites) if applicable

  • A general liability insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate

  • A copy of the policy and procedure for coverage arrangements with a participating provider and hospital, in the event of an emergency situation is required.

 

 

Dialysis Facility

Please include the following documents with your application:

  • Dialysis Facilities must be either accredited or certified by Centers for Medicare and Medicaid (CMS). One of the following accreditation certificates is needed (if applicable):

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • Accreditation Association for Ambulatory Health Care (AAAHC)

    • National Dialysis Accreditation Commission (NDAC)

  • A current copy of the Division of Health Service Regulation/ESRD Facility Survey Report

  • Medicare/Medicaid verification is needed (if applicable)

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.

  • In the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:

    • Number of cases less than $200,000

    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case

  • A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments)/ACR (American College of Radiology) must be in all provider files

  • A copy of the current Utilization Management Program

  • A copy of the current Quality Management (Quality Assurance) Program

  • A copy of the current Infection Control Plan to include infection rates and transfers from the Dialysis Center(s) to Acute Care Centers

  • A copy of all current services provided at the facility

  • A copy of the facility's one year of quarterly reporting of quality outcomes data for the following K/Dialysis Outcome Quality Initiative Indicators (K/DOQI):

    • Urea Reduction Ration (URR) = 65%

    • Urea Kinetic Modeling (Kt/V) = 1.2 Kt/V delivered vs. prescribed dose

    • Hemoglobin of 11-12 Grams

    • Hematocrit > 33% for premenopausal females and pre pubertal patients and 37% for adult males and postmenopausal females

    • Albumin of 3.5 to 5.2

    • Note: 80% of all patients must meet the K/DOQI measures

 

 

Durable Medical Equipment (Diabetic Supplies Only)

Blue Cross NC Only. Network closed for Diabetic Supplies and Equipment to NEW providers.
 
Please include the following documents with your application:
 
  • Medicare/Medicaid verification is needed (if applicable).
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • Non accredited Pharmacies must submit exemption letter from Medicare.
     
  • One of the following accreditation certificates is needed if no exemption letter from Medicare:
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The Community Accreditation Program, Inc. (CHAP)
    • Accreditation Commission for Health Care (ACHC)
    • The Compliance Team Inc's "Exemplary Provider Award Program"
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Healthcare Quality Association on Accreditation (HQAA)
    • National Association of Boards of Pharmacy (NABP)
    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)
    • American Board of Certification in Orthotics and Prosthetics (ABC)
    • Board of Certification/Accreditation International (BOC)
    • A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
       

 

Free Standing Radiology

Blue Medicare HMO and Blue Medicare PPO networks only.

Please include the following documents with your application:

  • A copy of a NC license or Certificate of Need (if applicable per state or federal regulatory requirements)
     
  • One of the following accreditation certificates is required:
     
    • American College of Radiology (ACR)
    • Inter-societal Accreditation Commission (IAC)
    • The Joint Commission (JCAHO)
       
  • Medicare certification
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites.
     

 

Home Durable Medical Equipment

Includes all Home Durable Medical Equipment which includes equipment only and cardiac event monitoring only.

Please include the following documents with your application:

  • A copy of the North Carolina Division of Health Service Regulation or North Carolina Board of Pharmacy Permit-Devise Dispensing Permit, Board of Pharmacy Permit-Devise and Medical Equipment
     
  • One of the following documents is needed:
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The Community Accreditation Program, Inc. (CHAP)
    • Accreditation Commission for Health Care (ACHC)
    • The Compliance Team Inc.'s "Exemplary Provider Award Program"
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Healthcare Quality Association on Accreditation (HQAA)
    • National Association of Boards of Pharmacy (NABP)
    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)
    • American Board of Certification in Orthotics and Prosthetics (ABC)
    • Board of Certification/Accreditation International (BOC)
       
  • Medicare/Medicaid verification is needed for each site (or letter attesting to all covered sites) if applicable.
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
       
  • A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.

 

Home Health Agency

Please include the following documents with your application:

  • Home Health Agencies must be accredited. One of the following accreditation certificates or letter attesting to all covered sites is required for each site:
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The Community Accreditation Program, Inc. (CHAP)
    • Accreditation Commission for Health Care (ACHC)
       
  • All of the following services must be provided in order to meet contracting requirements:
     
    • Skilled Nursing Visits
    • Speech Therapy
    • Physical Therapy
    • Home Health Aide
    • Occupational Therapy
    • Medical Social Services
  • A copy of the Division of Health Service Regulation license is required for each site
     
  • Medicare/Medicaid verification is needed (if applicable)
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate. General liability insurance face sheet must indicate practice/provider address.

 

Home Infusion Therapy

Please include the following documents with your application:

  • All of the following services must be provided in order to meet contracting requirements:
     
    • Pharmacy
    • Nursing
    • Supplies
       
  • A copy of the Division of Health Service Regulation License and Board of Pharmacy Permit-Infusion Services is required for each site.
     
  • Home Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS).
     
  • One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The Community Accreditation Program, Inc. (CHAP)
    • Accreditation Commission for Health Care (ACHC)
       
  • Medicare/Medicaid verification is needed for each site (or letter attesting to all covered sites) if applicable.
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
     
  • On the application form, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
     
    • Number of cases less than $200,000
    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.

 

Hospice Agency (Blue Cross NC Only)

Please include the following documents with your application:
 

  • Hospice must be accredited. One of the following accreditation certificates (or letter attesting to all covered sites) is required for each site:
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • Accreditation Commission for Health Care (ACHC)
       
  • A copy of the Division of Health Service Regulation license is required for each site.
     
  • Medicare/Medicaid verification is needed (if applicable).
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
     

 

Hospital

Please include the following documents with your application:
 

  • Hospitals must be accredited. One of the following accreditation certificates is required:
     
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • National Integrated Accreditation for Healthcare Organizations (NIAHO)
       
  • A copy of the Division of Health Service Regulation license is required for each site (or letter attesting to all covered sites).
     
  • Medicare/Medicaid verification is needed for each site (or letter attesting to all covered sites) if applicable.
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
     

 

Independent Diagnostic Testing Facility

For cardiac event monitoring services within Blue Medicare HMO and Blue Medicare PPO networks only

Please include the following documents with your application:
 

  • A copy of the CLIA Full (Level 3) certification or registration (Clinical Laboratory Improvement Amendments) if applicable
     
  • Accreditation by College of American Pathologists (CAP) or COLA, American College of Radiology (ACR), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Medicare certification is required:
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • Medicaid certification is needed (if applicable)
     
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites
     

 

Intensive Outpatient Facility (Blue Cross NC Only)

Please include the following documents with your application:
 

General Psychiatric Intensive Outpatient Facility (PIOP):

  • General Behavioral Health diagnosis other than substance abuse ie: Eating disorders, Autism, Depression
  • General Psychiatric Intensive Outpatient Facilities must be accredited. One of the following accreditation certificates is required
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • Medicare/Medicaid verification is needed (if applicable).
    • A. Note:Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • B. Note:If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)

Substance Abuse Intensive Outpatient Facility (SAIOP):

  • A copy of the Division of Health Service Regulation license for substance abuse services.
  • Substance Abuse Intensive Outpatient Facilities must be accredited. One of the following accreditation certificates is required
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • Medicare/Medicaid verification is needed (if applicable).
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)

 

Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)

Please include the following documents with your application:

  • One of the following accreditation certificates is needed (if applicable):
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Accreditation Association for Ambulatory Health Care (AAAHC)
    • Council on Accreditation for children and family services (COA)
    • Community Health Accreditation Program (CHAP)
    • Continuing Care Accreditation Commission (CCAC)
       
  • A copy of a North Carolina Business license
     
  • Medicare verification:
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • General liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate (or letter attesting to all covered sites).
     
  • In the application, if you've answered yes to any under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
     
    • Number of cases less than $200,000
    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
       

 

Opioid Treatment Facilities

Please include the following documents with your application:

  • Division of Health Services Regulation License to provider Opioid Treatment
     
  • DEA
     
  • SAMSHSA Certification ("provisional" SAMSHSA Certification will not be excepted)
     
  • Medicare Provider Number
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • National Accreditation (CARF, Joint Commission, Council on Accreditation, and National Commission on Correctional Health Care)
     
  • General and Professional Liability
     

 

Orthotics and Prosthetics

This includes all Orthotics and Prosthetics which will include Breast Prosthetics only.

Please include the following documents with your application:

  • One of the following accreditation certificates is needed:
     
    • The American Board of Certification (ABC)
    • The Board of Certification/Accreditation International (BOC)
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Community Health Accreditation Program (CHAP)
    • HealthCare Quality Association on Accreditation (HQAA)
    • National Association of Boards of Pharmacy (NABP)
    • The Joint Commission (JCAHO)
    • The Compliance Team, Inc.
    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)
    • Accreditation Commission for Health Care, Inc. (ACHC)
       
  • Medicare/Medicaid verification is needed (if applicable).
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
     

 

Partial Hospitalization (Blue Cross NC Only)

Please include the following documents with your application:

  • Partial Hospitalization Facilities must be accredited. One of the following accreditation certificates is required:

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • Commission on Accreditation of Rehabilitation Facilities (CARF)

  • A copy of the Division of Health Service Regulation license for Partial Hospitalization Services.

  • Medicare/Medicaid verification is needed (if applicable).

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)

 

Private Duty Nursing (Blue Cross NC Only)

Please include the following documents with your application:

  • Private Duty Nursing must be accredited. One of the following accreditation certificates (or a letter attesting to all covered sites) is required for each site:
     
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The Community Accreditation Program, Inc. (CHAP)
    • Accreditation Commission for Health Care (ACHC)
       
  • A copy of the Division of Health Service Regulation license is required for each site.
     
  • Medicare/Medicaid verification is needed (if applicable).
     
    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       
  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.

 

Reference Laboratories

Please include the following documents with your application:

  • CLIA certificate Full (Level 3)
     

  • Accreditation by College of American Pathologists (CAP) or COLA (if applicable)
     

  • If not accredited by an accrediting agency (CAP or COLA) needs CMS site survey
     

  • Medicare certification
     

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       

  • Medicaid certification is needed (if applicable)
     

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
     

 

Residential Treatment Facilities (Blue Cross NC Only)

Please include the following documents with your application:
 

  • Residential Treatment Facilities must be accredited. One of the following accreditation certificates is required:
     

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • Commission on Accreditation of Rehabilitation Facilities (CARF)
       

  • A copy of the Division of Health Service Regulation license
     

  • Medicare/Medicaid verification is needed (if applicable)
     

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
       

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
     

 

Skilled Nursing Facility

Please include the following documents with your application:

  • If not accredited, please provide a copy of the most recent CMS Review.

  • If you are qualified and enrolled with the National Supplier Clearinghouse as a Medicare certified DMEPOS supplier one of the following accreditation certificates is needed:

    • The American Board of Certification (ABC)

    • The Board of Certification/Accreditation International (BOC)

    • Commission on Accreditation of Rehabilitation Facilities (CARF)

    • Community Health Accreditation Program (CHAP)

    • HealthCare Quality Association on Accreditation (HQAA)

    • National Association of Boards of Pharmacy (NABP)

    • The Joint Commission (JCAHO)

    • The Compliance Team, Inc.

    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)

    • Accreditation Commission for Health Care, Inc. (ACHC)

  • Copy of the Division of Health Service Regulation license

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.

  • Medicare verification is required for each site (or letter attesting to all covered sites).

  • Medicaid verification is needed for each site (or letter attesting to all covered sites) if applicable.

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.

  • On the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:

    • Number of cases less than $200,000

    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.

 

 

Sleep Center (Blue Medicare HMO and Blue Medicare PPO networks only)

Please include the following documents with your application:

  • Medicare/Medicaid certification is required (if applicable).

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.

  • One of the following accreditation certificates is needed (if applicable):

    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

    • The Community Accreditation Program, Inc. (CHAP)

    • Accreditation Commission for Health Care (ACHC)

    • International Standards Organization (ISO)

    • The Compliance Team Inc.'s "Exemplary Provider Award Program"

    • American Academy of Sleep Medicine

  • A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)

 

 

Specialty Pharmacy

Please include the following documents with your application:

  • Board of Pharmacy Permit-Devise and Medical Equipment Permit is required

  • Medicare certification is required.

    • Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.

    • Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.

  • Commercial General Liability Insurance of at least 1 mil/3 mil.

  • A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) if applicable.

  • Accreditation by URAC

  • In lieu of the Accreditation by URAC, we can accept pharmacies that have received federal designation as a Hemophilia Treatment Center

 

 

 

Part 3

Register your NPI number

We recommend that you register your NPI number at the time you send in your credentialing application and supporting documents to help save you time.

You'll need to fill out and send an enrollment application and a tax ID form so Blue Cross NC can register your NPI. In addition to your registered NPI, you'll also need to have an active contract with Blue Cross NC. This will allow you to file claims for services provided to Blue Cross NC members.


Start NPI Registration Process

 

Common Questions

Fill out the application, attach all appropriate documents and email, fax or mail them to us at:

Email
credentialing@bcbsnc.com

Fax
(919) 765-7016

Mail
Blue Cross and Blue Shield of North Carolina
Attn: Credentialing Department
P. O. Box 2291
Durham, NC 27702

If your application is incomplete or if you have not submitted all of the required documents, we'll contact you within 15 days of receiving it requesting the missing information. Your incomplete application will be closed 60 days from when we receive it if the requested information isn't received.

After you send the completed application and documents, you'll be presented to the Credentialing Committee for approval or denial. If denied, you'll be notified by certified mail. If approved, a Network Management associate will contact you to finalize the contracting process and assign your effective date.

Please don't send any claims until you've received an effective date for participation into the Blue Cross NC network. Claims aren't eligible for payment until a Blue Cross NC participation effective date has been decided.

For Facilities:

  • Be sure you fill out the entire form and enter N/A where appropriate. If you leave any fields blank, your application will be considered incomplete and won't be processed.

  • Send a completed application for each site and each organization that has a unique Federal Tax ID#.

For Providers:

  • Be sure you fill out the entire form and enter N/A where appropriate. If you leave any fields blank, your application will be considered incomplete and won't be processed.

  • Include a copy of liability insurance.

  • If you have a single medical malpractice judgment case settled for $200,000.00 or multiple malpractice cases settled for any amount, you'll need to include two letters of recommendation from physician peers.
    Download Letter of Recommendation form

For Facilities:

  • You'll need to fill out a Uniform Application.
  • You'll also need to complete and send us your application
  • You'll need to send documents specific to your specialty. 

Manual Facility Applications

For Providers:

  • You'll need to fill out a Uniform Application.
  • You'll also need to complete and send us your application
  • You'll need to send documents specific to your specialty. 

Manual Provider Credentialing

 

  • Providers