Credentialing

As part of an ongoing commitment to both our subscribers and our network practitioners, BCBSNE has developed a credentialing program that must be completed prior to participation. Credentialing policies and procedures have been established in compliance with Nebraska law, and modeled after URAC and NCQA standards.

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. Both fillable and non-fillable versions of the form are 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 on our Find a Form page.  
  • 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.

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: 

  • Acceptance letter will be sent – this is NOT your effective date.
  • Wait for letter that will come via email with an EFFECTIVE date.
  • Once that letter is received you can:
    • Submit claims
    • Get NaviNet access
      • Benefits and eligibility
      • Claim status
      • File appeals, reconsiderations, timely filing override requests
      • Perform claim investigation
      • And more.
  • Do not submit claims before receiving the EFFECTIVE date email. 

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

A minimum of 30-45 days advance notice is required from either the group or the PHO that the group is moving to. Please send all of the information below to DelegatedNotices@NebraskaBlue.com

  • Provider Name (of the provider and/or practice) moving
  • Name of entity moving FROM
  • Name of entity moving TO
  • Tax ID
  • Address
  • Effective date (month/day/year)
  • Per credentialing guidelines, effective dates will not retro – this is the reason for advance notice
  • Term notice from the group or previous PHO
  • Roster of providers (this is used as a sync up to make sure we’re moving all the correct providers)
  • 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
  • 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

Send an email to HealthNetworkRequests@NebraskaBlue.com with the following information:

  • Provider Name (of the provider and/or practice) terming
  • Provider NPI
  • Tax ID
  • Address
  • Term date (month/day/year)

Please ALSO include the following (if applicable):

  • No longer participating with BCBSNE
  • Transferring your contract to another group
    • Indicate which group you are working with so that we can coordinate efforts

Termination request without a transfer notice, BCBSNE will process termination, notification letters sent out to all members that have seen the provider within the last 18 months.

Termination request with transfer notice, BCBSNE will sync with both parties and transfer accordingly, termination letters will not be sent out.

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