HCSC Credentialing Services for your Independent Practice

The Health Care Service Corporation (HCSC) has medical policies that serve as guidelines for health care benefit coverage decisions, which may alter depending on the various goods and benefit plans offered by each state.Medical policies are based on evidence from peer-reviewed scientific literature, specialist society criteria, and guidelines accepted by other health care groups. In addition to active and pending medical policies, HCSC has included policies that are in the process of being developed or updated.

Provider Rights

Candidates applying for or re-apply for membership in the Health Plan networks have the right to be notified of the following:

• Right to see documents provided on or with their credentialing and re-credentialing applications

• Right to correct incorrect and/or conflicting information

• On request, they have the right to know the status of their credentialing or re-credentialing applications

If incorrect information is detected during the verification process from any primary source, the Enterprise Credentialing Department will notify the applicant in writing. Applicants will be given 30 calendar days to correct any incorrect or contradictory information and resubmit their applications to the Enterprise Credentialing Department, your allocated Provider Network Consultant, or the Medical Director. It will be the applicant’s obligation to deal directly with the reporting company to correct any incorrect or contradictory information.

Our Specialist will assist you to get your credentials as soon as possible!

We will review your educational history, career experience, credentials, and registration to practice in the healthcare industry during the credentialing process. Throughout the credentialing process, we will monitor your progress to determine your education, training, credentials, and registration to practice in a health care setting.

We will examine all of your documents to ensure that you have been certified by one of the world’s most prominent healthcare providers. As a team, we are devoted to long-term growth. We will help you obtain the services you desire. This is how we show our appreciation to our customers and demonstrate our commitment to providing great customer service.

Credentialing Process

CAQH will gather the information needed for our credentialing and Re-credentialing processes.

CAQH collects data electronically using the ProView credentialing system. Our administrative simplicity and paper reduction efforts are aided by the proView online credentialing application procedure. This solution also helps to maintain the correctness and integrity of our supplier database, which supports quality initiatives. Providers can use the proView database for free.

First-time users: (If you have not previously registered with CAQH).

• It is now possible for providers to obtain a CAQH number on their own. Go to the CAQH website, click “Register Now,” and fill out the online form.

• CAQH will send you an email with a Welcome Kit containing registration instructions as well as your own CAQH Provider ID, allowing you to have immediate access to the proView database through the Internet.

• After receiving your CAQH Provider ID, go to the CAQH website to register.

• You will be able to access the system after successfully authenticating crucial information by creating your own user name and unique password.

• After completing registration, you can log in at any time using your login name and password.

Existing customers:

If you have previously registered your CAQH Provider ID and completed your proView online application, make sure BCBSIL has permission to access your credentialing information. This can be done in four simple steps, as detailed below. (If you choose “global authorization,” BCBSIL already has access to your data.)

• To grant BCBSIL access to your data, follow these steps:

• Enter your login and password at HTTPS://PROVIEW.CAQH.ORG/OAS.

• Navigate to the Authorize tab (located on the bottom left of main page)

• Scroll down and tick the box next to BCBSIL, or choose “global authorization.”

• To save your changes, click the Save button.

Finishing the Application Process

The ProView standardized application is a single, standardized web form that caters to the needs of all collaborating health care companies. You will indicate which participating health plans and health care organizations you want to have access to your distributed applications when you complete the application. CAQH stores all provider data submitted through the proView service in a secure, cutting-edge data center.

Documents that may be needed to complete the online application:

• Pre-existing credentialing application (for reference)

• Locations of former and ongoing practice

• Several identifying numbers (UPIN, NPI, Medicare, Medicaid,etc.)

• Medical license from the state (s)

• Drug Enforcement Administration Curriculum Vitae (DEA) Controlled and • Dangerous Substances Certificate (CDS) Form W-9 IRS Certificate (s)

• Face sheet for malpractice insurance

• A summary of any malpractice cases that are now underway or have been settled.

You will also be required to:

• Authorize access to your information after completing the online application.

• Check the organizations that you have given permission to share your information or give a global permission.

• Attest to the accuracy of your data entry.

• Examine your data summary for quality and completeness, and make any necessary modifications.

• Please submit any supporting documentation.

• Directly upload supporting documents to the proView website. Documents supporting this claim include:

• Medical license from the state (s)

• The Drug Enforcement Administration (DEA) (DEA) Controlled and Dangerous Substances Certificate (DPS) Face sheet for Certificate of Malpractice Insurance

• Any pending or settled malpractice case(s) – if during the last ten years

• Curriculum Vitae (C.V.)

• Attestation (printed and signed on page 18 of the online application)

Check Credentialing Status

To check the status of your credentialing process, enter your NPI or license number at that website
www.hcscproviderintake.secure.force.com/CredentialStatus

Credentialing Updates

CAQH will send you direction regarding to examine and validate your data. Use the ProView database to record any changes to your practice within the time constraints specified in the State of Illinois Health Care Professional Credentials Data Collection Act, which are as follows:

• Within 5 business days for revoking of a state health care professional license, revoking of a federal drug control agency license, Medicare or Medicaid punitive measures, revocation of hospital rights, any lapse in professional liability insurance required by a health care entity, insurance plan, or hospital, or a criminal record.

• Within 45 days of discovering the change, for any other data provided on your credentialing request, such as practice address, hospital affiliation, and so on.

Re-Credentialing

Re-credentialing follows the same procedure as credentialing and is in accordance with NCQA and State of Illinois criteria. If your credentialing request is not accessible to BCBSIL because you’ve never finished the ProView credentialing procedure, you will be added to our register and CAQH will give you a Welcome Kit with your CAQH Provider ID in order for you to complete the ProView credentialing process. This will assist you in adhering to the terms of your network agreement.
HCSC Phone Number:800-654-7385 call at this number for more queries.