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Medicare Providers

Joining Our Network is Easy!

We’re glad to hear that you are interested in joining our network. We have a diverse network of exceptional health care professionals that ensure our members have uninterrupted access to the health care they need.

You make your patients' lives better. We'll do the same for you.

Our prior authorization, referrals, claims and payment processes are streamlined to help you focus on what you do best — caring for your patients.

Credentialing with us

Credentialing is the process we use to evaluate and select licensed independent practitioners to provide care to our members.

We use the Council for Affordable Quality Healthcare (CAQH) ProView┬«*  application for credentialing. This secure and private portal reduces the amount of paperwork you need to fill out to complete the credentialing process.

Credentialing overview

Why do we credential?

Credentials are evaluated according to criteria set forth in our policy to ensure the competency and conduct of the health care professionals serving members in our network.

Whom do we credential?

We credential licensed health care professionals with whom the company intends to contract and market to our members. The Provider Manual  includes a complete list of provider types we credential and those we do not.

Please note: Facilities (health delivery organizations) may also need to be credentialed before joining the network.

Credentialing process

  1. Register with CAQH (if you are not already registered). You may self-register by visiting https://proview.caqh.org. This is a secure and private portal.
  2. Authorize Healthy Blue so we can access your credentialing information. If you are already registered with CAQH, you will need to give us permission to review your information.

    If you need assistance, call the CAQH Provider help line at 1-888-599-1771.

  3. Review and update your application. Please ensure all sections of the application are complete and accurate.

A complete application includes:

  • Your signature and application date.
  • CAQH status of Initial Application Complete or Reattestation.
  • Current license to practice in each state where services are provided.
  • Education/training to support requested specialty(ies) (or documentation that provider will complete training within 60 days of application).
  • Current hospital privilege information.
  • Current DEA or CDS certificate in each state where services are provided.
  • Explanations to questions on the application.
  • Five years’ work history, in month/year format.
  • Current professional liability insurance.
  • Applicant must also allow a site review within 30 days of our request, if applicable.

The credentialing process typically takes 45 days from the time the Credentialing department receives your completed CAQH application.

Recredentialing

We recredential network providers every three years. If your CAQH application is current and complete at that time, no additional effort on your part may be required. If CAQH is expired or missing information, we will contact you to update the information.

Non-response to recredentialing requests

If you do not update CAQH or supply the required information for recredentialing by the due date, your application will be considered incomplete and will result in an administrative termination from the network.

Providers’ rights

Providers have the right to:

  • Review information submitted to support their credentialing application.
  • Correct erroneous information.
  • Receive the status of their credentialing or re-credentialing application upon request.

To review your application or correct submitted information, please call our Credentialing team at 1-844-421-5662.

Provider Tools & Resources

Interested in becoming a provider in our network?

We look forward to working with you to provide quality services to our members.