Manually Apply for Provider Credentialing

Common Questions

Where do I send my application and documents?

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

What happens if my application is incomplete?

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.

What can I expect after I send in my application?

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.

I'm credentialed, now what?

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.

How do I avoid processing delays with my application?

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

Can I submit applications manually?

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

• Please send a copy of your residency certificate with the school's seal of authenticity and the completion date.  

• Provider must be Board Certified or Board Eligible (Residency/Fellowship Trained) in one of the following specialties:
  • Anesthesiology
  • Physical Medicine Rehab
  • Neurology
  • Psychiatry
• Fellowship in Pain Medicine (Board Certified/Eligible for Subcertification of Pain Medicine by an ABMS Board)

Include the following:

• Copy of North Carolina Board of Pharmacy License
• Proof of current CPR certification issued by the American Red Cross or American Heart Association or equivalent
• Immunization Certificate of Achievement
• Certificate of Insurance of at least $1 million per occurrence and $3 million aggregate
• Copy of the face sheet of your current professional liability insurance policy, indicating by name, provider(s) covered coverage amounts, start date, expiration date, and policy number
• Copy of up-to-date physician's written protocol, standing medical order, or other order of protocol

• Please send a copy of your certificate/graduate diploma with the school's seal of authenticity and the completion date

• Provider must be Board Certified or Board Eligible by an ABMS member board (Residency/Fellowship Trained) in one of the following specialties:
  • Family Medicine
  • Internal Medicine
  • Otolaryngology
  • Pediatrics
  • Neurology
  • Psychiatry
  AND
  1. Sub-certified in Sleep medicine by one of the ABMS member boards listed above.
     OR
  2. Completed an ACGME accredited fellowship in Sleep Medicine