Blue Cross Blue Shield of Texas (BCBSTX)

General Requirements:

• Provider Record ID: You’ll generally need a valid BCBSTX Provider Record ID for claim payment. This is usually obtained through an initial enrollment process.
• Signed Agreement: A current, signed BCBSTX contract or agreement is required.  
• CAQH Provider Data Portal (f.k.a ProView): BCBSTX mandates the use of the Council for Affordable Quality Healthcare (CAQH) ProView database for initial credentialing and recredentialing for physicians and professional providers. Complete the online application with “global” or “plan specific” authorization granted to BCBSTX. Failure to finalize your CAQH application within 45 days can lead to discontinuation of the process.
• Texas License: A valid, unrestricted license to practice in the state of Texas, in good standing with the relevant Texas Licensing Boards, is essential.
• Professional Liability Insurance: You’ll need current professional liability insurance coverage with minimum limits. For Texas providers, the minimum requirement has been $100,000 per occurrence and $300,000 in aggregate (this was updated from a previous $200,000/$600,000 requirement). Specific ancillary providers may have different liability coverage requirements (e.g., Home Health Agencies may require $500,000/$1,000,000).  
• Work History: Initial credentialing often requires a work history of the past five years with no gaps greater than six months, or explanations for any such gaps.
• Hospital Affiliations (MDs/DOs): Information on admitting arrangements and hospital privileges may be required. A Facility Coverage Letter might be accepted in lieu of privileges in some cases.
• DEA/CDS Certificate: If applicable to your practice, a current DEA (Drug Enforcement Administration) or CDS (Controlled Dangerous Substances) certificate for each state where services are provided may be necessary.  
• Board Certification: Information on board certifications, if applicable to your specialty.
• General Information: Basic personal details like name, date of birth, social security number (last four digits or NPI), and contact information are required.  
• Practice Location Information: Details of your primary practice location(s), including address, phone, fax, email, and Tax Identification Number (TIN).
• Attestation and Release: You’ll need to sign and date an attestation confirming the accuracy of the information provided and authorize BCBSTX to verify your credentials.

Specific Requirements for Different Provider Types:

• Physicians and Professional Providers: Primarily use CAQH ProView for initial credentialing and recredentialing. Those not listed in CAQH’s approved provider types may need to complete the Texas Standardized Credentialing Application from the Texas Department of Insurance (TDI) website.  
• Hospitals, Facilities, and Allied Providers: These entities also undergo a credentialing process. They need to complete the appropriate enrollment form based on their facility type and provide the required documentation. Facilities can often submit credentialing applications through Availity™. Recredentialing is typically required every three years.  
• Ancillary Providers: Have a specific credentialing and contracting process. They often need to first obtain a Provider Record ID by submitting an Ancillary Provider Record Request Form. Following this, they complete a Credentialing/Recredentialing Ancillary/Hospital Provider Questionnaire and submit it with required documentation (e.g., licenses, liability insurance, accreditation if applicable).
• Durable Medical Equipment (DME) Suppliers and other specialties: Have specific checklists outlining required licenses, insurance, and accreditations.

Key Steps in the Credentialing Process:

1. Obtain a Provider Record ID:

https://www.bcbstx.com/provider/network/network/provider-onboarding-process

1. Complete the CAQH Provider Data Portal application:

https://proview.caqh.org/Login/Index?ReturnUrl=%2f

1. Provide all required documentation, such as licenses, insurance certificates, and other supporting materials.
2. Authorize BCBSTX to access your CAQH data (if applicable).
3. Attest to the accuracy of your information and sign the required forms.
4. Submit the completed application and documentation to BCBSTX.
5. BCBSTX will review the application and verify your credentials through primary sources. This review can take approximately 8-10 calendar days once the CAQH application is complete.  
6. You may be required to undergo a site review (for facilities).
7. BCBSTX will notify you of the credentialing decision. Approval is required before you can participate in their networks.

Recredentialing:

• BCBSTX requires recredentialing of network providers every three years.
• Physicians and professional providers will use CAQH ProView for recredentialing, needing to review and attest to their data.  
• Hospitals, facilities, and allied providers use a specific Credentialing and Recredentialing Facility and Allied Provider Form.

Important Considerations:

• Timeliness: Completing the CAQH application within 14 days of submitting your enrollment form is often recommended. Failure to finalize it within 45 days can lead to discontinuation.  
• Accuracy: Ensure all information provided is accurate and complete to avoid delays. Incomplete or duplicate applications can result in delays.  
• Updates: You are responsible for informing BCBSTX of any changes to your practice information (demographics, etc.) in a timely manner, typically within 30-45 days of the change, often through the CAQH portal.  
• Provider Manuals: Refer to the BCBSTX Provider Manuals for detailed policies, procedures, and requirements. There are specific manuals for different networks (e.g., PPO, Medicaid STAR/CHIP).  
• Credentialing Status Checker: BCBSTX often provides an online tool to check the status of your credentialing process using your NPI or license number.

Summary Table: BCBS Credentialing Steps in Texas