Provider Credentialing
Individual providers, hospitals, and other facilities must be credentialed prior to participation in BCBSMT provider networks as outlined in the Provider Network Participation Policy. To obtain a credentialing application, contact us at 1.800.447.7828, Extension 3600 or by email at HCS-X3600@bcbsmt.com.
The Process
After a completed application is received, we verify the applicant's data. Then, a Credentialing Committee evaluates the applicant's professional qualifications, such as training, licensure, certifications, and background as well as professional competence and conduct, as summarized in the standards. Click on the links below for more information.
When the process is complete, the applicant receives written notification of his/her professional status with BCBSMT. To be considered a network provider, the credentialing process must be complete. For the status of a submitted application, contact us at 1.800.447.7828, Extension 3600 or by email at HCS-X3600@bcbsmt.com.
Completing Your Application
The credentialing process may begin before you start to practice. Please submit an application as soon as possible to avoid delay in becoming a participating provider. The process takes an average of 45 days to complete once an application is received.
For assistance completing your application, click on the guideline links below or contact us at 1.800.447.7828, Extension 3600 or by email at HCS-X3600@bcbsmt.com.
Recredentialing
Recredentialing is performed every 3 years. It entails providing an update of the information you provided during the previous credentialing process and signing new consent and attestation forms. All information is again verified and the application is presented to the Credentailing Committee for consideration. Please return the recredentialing application in a timely manner so your participation in the networks is not jeopardized.
Continuing Medical Education
The completion of 75 Category I CME is required between each credentialing cycle. The following web sites offer free or low-cost continuing medical education credits:
Credentialing Tips
To help ensure the completeness of your credentialing application and expedite the process, pay particular attention to the following details.
Admitting Privileges
Physicians (MD, DO, DPM) are required to have admitting privileges OR a formalized Admit Plan. An Admit Plan must include the following:
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Documentation of the plan for having patients who require inpatient hospitalization admitted by physicians of the same specialty, specfiically naming the physician(s) with whom a formal arragnemnt has been made to admit on the applicant's behalf
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Documentation verifying a formal arrangement for admissions from the physician(s) who have agreed to admit on the Applicant's behalf
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24/7 coverage
Work History
Provide a chronological practice history since the completion of your professional graduation or training. Please be sure to account for all time, providing months and years and an explanation of what you were doing during any gaps in time.
Drug Enforcement Certification
Physicians (MD, DO, DPM), Physician Assistants, Nurse Practitioners, Certified Nurse Mid-Wives, Certified Registered Nurse Anesthetists, and Optometrists are required to have a current DEA certification at the time of credentialing. Submit a copy of the certificate with your application. If you prescribe under the authority of a hospital's DEA, provide a copy of the hospital's DEA.
Allegations of Malpractice
The credentialing application requests disclosure of any allegation of malpractice, regardless of the outcome or current status. Provide details of each incident including:
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A brief case presentation
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Initial findings
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Treatment
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Other practitioner's involvement, if any
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Patient outcome
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Plaintiff's allegation
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Current status or disposition, including settlement amount, if any
