BlueCross of California Credentialing Services

We appreciate the value of creating and maintaining strong relationships with healthcare professionals, as well as the difficulties that underserved California communities face in accessing healthcare services at Blue Shield of California Promise Health Plan.

Blue Shield will accredit healthcare providers who sign a direct contract with Blue Shield to join our network. Practitioners must submit a completed, signed, and dated California Participating Practitioner Application, as well as any other supporting documentation listed on the Blue Shield Credentialing Checklist, which is included with the application.

The application procedure is divided into two stages: credentialing and contracting.

Credentialing: Submit your completed initial credentialing application or CAQH request form to Blue Shield’s Credentialing Department. Blue Shield’s Credentialing Committee reviews credentialing applications and corresponding information and formally approves or denies them. When the Credentialing Committee review is completed, providers will be notified. See the information for

Contracting: Once the Credentialing Committee has approved the Independent Provider Agreement, submit it to Blue Shield’s Provider Information & Enrollment Department. Agreements provided prior to or at the same time as the first credentialing application will be returned to ensure Blue Shield has all current required documentation.

Our Specialist will help you to get credentialed now.

We will primarily evaluate your educational history, career experience, certificates, and registration to practice in a healthcare sector during the credentialing process. We will track your progress throughout the credentialing test in order to determine your education, training, credentials, and registration to practice in a health care context. We will check all of your paperwork to ensure that you are certified by one of the world’s most prestigious healthcare specialists. As a team, we are committed to long-term development. We will assist you in obtaining the services you require. This is how we show our thanks for our consumers and our commitment to their satisfaction.

Requirements

To join our networks, you must be a member of an Independent Practice Association (IPA) or a medical organisation that has a Blue Shield contract. Otherwise, you must enter into a direct arrangement with Blue Shield.

Blue Shield will accredit healthcare providers who sign a direct contract with Blue Shield to join our network. Practitioners must submit a completed, signed, and dated California Participating Practitioner Application, as well as any other supporting documentation listed on the Blue Shield Credentialing Checklist, which is included with the application.

Participation in the Blue Shield of California network is subject to the following requirements:

• If appropriate, specialist board certification from a recognized U.S. specialty board, such as the American Board of Medical Specialties (ABMS), or successful completion of a residency in your specialty or field of practice in the United States. General practitioners must have one year of postgraduate training and two years of training in the requested specialty programme.

• A valid, unrestricted California medical license granted by the proper licensing board is required. A probationary license is deemed restricted.

• Staff privileges at a Blue Shield contracting hospital for physicians. Physicians who do not ordinarily have hospital admitting privileges may be granted an exception. In some circumstances, the physician without admitting credentials must employ an admitting panel or give assurance that the patient will be admitted by another Blue Shield network physician with admitting privileges.

• Current professional malpractice liability insurance in the amounts of $1,000,000 per occurrence and $3,000,000 per year. The standards for allied health and non-physician behavioral health are $1/$1 million.

• A completed professional malpractice liability questionnaire, providing a breakdown of all claims, settlements, and open cases.

• There are no current licensing issues, such as an unresolved accusation by a board that gives the relevant license to practice.

• A current unrestricted Drug Enforcement Administration (DEA) registration number, if applicable.

Re-credentialing

CAQH ProView® will be utilized to re-credential, or re-attestation. It is the process of logging into CAQH ProView, making changes as needed, and then attesting, or certifying, that all of the information is right. Every 120 days, retesting is required.

BlueCross of California Phone Number

Members of Blue Shield of California who require immediate assistance can call customer support at 800-393-6130.

BlueCross of California Email Address

Members of Blue Shield of California; who require immediate assistance can contact customer support through email address: PromiseLOI@blueshieldca.com

BlueCross of California Enrollment Form