BCBSNC Requires Mid-level Clinicians to Be Credentialed By January 2017

Blue Cross and Blue Shield of North Carolina (BCBSNC) has notified its practices that, come January 2017, nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) at in- network practices will be required to be credentialed by BCBSNC just as physicians currently are.

Through its credentialing process BCBSNC requires individual practitioners to meet a minimum set of credentialing criteria, based on their care specialties before they are eligible to perform in-network services for BCBSNC members. The practitioners must be re-credentialed every three years.

BCBSNC is requesting NPs, PAs, and CNMs (or their organizational credentialing departments) to initiate the credentialing process as soon as possible. Instructions on how to begin are available on bcbsnc.com on the “Providers” home page by opening the link located within the blue box, labeled “Become a BCBSNC Provider.”

The credentialing process can take up to 60 days from the date a credentialing application is received by BCBSNC to complete. BCBSNC follows the credentialing guidelines established by the National Committee for Quality Assurance (NCQA) and the North Carolina Department of Insurance (NCDOI). Following a NP’s, PA’s, or CNM’s completion of credentialing, the credentialed provider’s name and group affiliation will become eligible for display in BCBSNC’s online provider directory, “Find a Doctor.”

Failure to complete credentialing by January 1, 2017, may result in a mid-level provider’s inability to provide in-network services for BCBSNC’s commercial membership, according to the announcement. BCBSNC intends to conduct claims audits, and therefore, services determined to have been provided by a non-credentialed NP, PA, or CNM, after January 1, 2017, may be denied or adjusted, if the services were performed while working as part of, or under the supervision of a provider within an in-network health care organization.

Please contact a representative of BCBSNC’s provider networks (formerly named Network Management) if you have questions about this new requirement for mid-level providers. BCBSNC representatives also can help you initiate the credentialing process, and are available by phone at 1-800-777-1643.

 
 

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