Credentialing

Learn more about the standards expected below.

• Practitioner Initial and Recredentialing Standards Matrix
• Facility/Institution Initial and Recredentialing Standards Matrix
• Provider Appointment Access and Availability Standards
• Provider Network Access Standards
• Medical Record Standards
• Facility Standards for Practitioner Offices
• Facility Standards for Urgent Care Offices

To streamline the credentialing application process, we work with CAQH. Complete one online application for use with over 650 of the nation's leading health plans, hospitals and practitioner groups, saving you time and paperwork. Providers must be licensed in order to be credentialed (some exceptions may apply).

Apply for Credentialing through CAQH »

After you complete the credentialing application process through CAQH, please fill out the credentialing form and send it to BCBSNE using the instructions provided at the bottom of the form. The form is available on our Find a Form page. 

We’ll use the details you provide on the form to obtain information from the CAQH database. BCBSNE will process requests in the order they are received. Please do not submit requests to BCBSNE more than 60 days prior to the start date of the provider. 

Please note: If you are:

• A provisional provider or registered behavioral technician, please complete the Credentialing - Provisional Provider form available only through NaviNet^® via the Administrative Updates/Secure Forms.  
• Part of a physician hospital organization (PHO), please contact your PHO representative directly. You do not need to complete this credentialing form.  

We've reviewed the provider community's most-asked questions and created this online resource library to offer you easily-accessible information and process transparency. These guides should always be the first stop to verify or clarify any portion of the credentialing process.

• Credentialing Timeline
• CAQH Credentialing Steps
• CAQH User Training

Log into CAQH to check application status »

You can also make a manual request for status updates. Please allow additional time to process manual status updates as these require in-depth research by our credentialing staff.
How to Manually Request Status.

Additionally, see  Top Causes of Credentialing Delays.

After you’ve applied and gone through the process: 

• The Credentialing Determination letter will be emailed to you with your effective date. However, we ask that you refrain from submitting claims or providing services to members until you also receive your Acceptance letter.
• Once you receive both letters, you can:
  • Submit claims
  • Get NaviNet access
    • Benefits and eligibility
    • Claim status
    • File appeals, reconsiderations, timely filing override requests
    • Perform claim investigation
    • And more.

When an entire TIN is moving from one contract/credentialing entity to another contract/credentialing entity, we require all of the below information to ensure there are no gaps in moving provider information. This is to help prevent abrasion or disruption of claims. 

Sending the information below is the responsibility of the PHO the group is moving to. Transfers will not be processed without all of the required information. Please send the information below to DelegatedNotices@NebraskaBlue.com. 

• Contract transfer notice should be sent separately and not in the same email as other updates
• Subject line of email CONTRACT TRANSFER || Group Name
• Provider Name (of the provider and/or practice) moving
• Name of entity moving FROM (I.E. direct contract, PHO)
• Name of entity moving TO (I.E PHO, direct contract)
• Tax ID
• Address
• Effective date (month/day/year) – a minimum of 30-45 days advance notice is required
• Term notice on letterhead from the group or previous PHO – the transfer will not be processed without this notice
• Roster of providers (this is used as a sync up to make sure we’re moving all the correct providers) – no update to your existing s/s format is needed, it just needs to be on it’s own sheet/email
• Listing of current contracts (current networks – MedA, BluePrint, Premier Select Blue, etc.) this will help us identify any narrow networks which may be lost in the transition to a new PHO

Per credentialing guidelines, effective dates will not retro – this is the reason for advance notice. Please do not submit claims until you have received notification the transfer is complete. All claims submitted prior to receiving the notification must be resubmitted for processing.  
 

Note:  Network transfers are the responsibility of the provider to maintain and ensure transfers are done appropriately

To terminate a location you currently practice at, please archive the location within your CAQH profile. This update will be made within 48-hours from submission.
 
To terminate a provider (all locations) or a Tax ID, please send an email to HealthNetworkRequests@NebraskaBlue.com with the following information:

• Provider name of the provider and/or practice terminating
• Provider NPI
• Tax ID
• Address
• Termination date (month/day/year)
• The group your contract should be transferred to and which group (if applicable) 

For termination requests without a transfer notice to another group, BCBSNE will process the termination and send a letter to all members that have seen the provider in the last 18 months. This applies when the provider is no longer active under an existing agreement at any location.

For termination requests with a transfer notice to another group, BCBSNE will sync with both parties and process the transfer accordingly. A notification is not sent to members. This applies when the provider will remain active under an existing agreement at any location.

If claims were received after the requested termination date, you will be contacted to validate the termination date. We may request corrected claims are submitted. For additional information on submitting corrected claims, please refer to the Corrected Claims policy.

Please allow up to 15 days for completion of this process. After the termination is processed, please allow up to 24 hours for updates to be displayed in the Provider Finder.