How to Join the BCBSMT Provider Networks

Blue Cross and Blue Shield of Montana (BCBSMT) appreciates your interest in becoming a contracted provider with our health care organization. We contract with physicians, facilities, and other health care professionals to ensure that our members receive accessible, cost effective, and quality health care services.

Prior to participation, rendering providers must request and obtain a BCBSMT provider record. The provider record associates the provider's rendering National Provider Identifier (NPI) with their billing NPI and tax identification number (TIN).

Easy Steps to Join the BCBSMT Provider Network

You can join the BCBSMT provider network in the following easy steps:

Step 1 — Get Set Up

Before you can join the BCBSMT Provider Networks, you will need to be assigned a BCBSMT Provider Record ID.

Practices New to BCBSMT: To get set up, go to Request a BCBSMT Provider Record ID.

Providers Joining an Existing Contracted Practice: To get set up, complete and submit the "Add Sheet"/ Exhibit B of the Professional Provider Agreement. Skip Step 2

Note: Requesting a provider record from BCBSMT does not mean you are a participating network provider. You must obtain a BCBSMT Provider Record ID before moving to Step 2.

Step 2 — Complete the Contract

After you have been set up with a BCBSMT Provider Record, BCBSMT will forward you a contract. Sign date and return the contract.

Step 3 — Complete Credentialing

Once a Provider Record has been created, you will need to be credentialed.

  1. Credentialing Process for Physicians and other Professional Providers , register online and complete the CAQH Proview credentialing application, or if already, registered with CAQH, log in and update any outdated information.
    • The online CAQH application can be completed at any time.
    • The BCBSMT credentialing process does not begin until after the Provider Record is created and you have submitted a complete CAQH application, including required documents.
    • The BCBSMT credentialing process takes an average of 45 days to complete.
  2. Credentialing Process for Hospitals and other Ancillary Providers
    • A hard copy application will be sent to you with your contract. Complete and return the application, along with the requested documents to BCBSMT.
  3. You will be notified of your approval to the networks and the effective date. The effective date is your credentialing approval date. Contract effective dates are not backdated.

Tips:

  • Ensure Your Montana Practice Address is provided and marked as the Primary Address
  • Ensure the malpractice Certificate of Insurance includes the individual provider's name

Step 4 — For participation in the BCBSMT HELP Plan network an additional provider enrollment and screening process is required.

Click here to learn about the HELP Plan and obtain the forms required for participation in this network.

Step 5 — Get Connected

Participation in all electronic options available to BCBSMT providers is strongly encouraged.


Request a BCBSMT Provider Record ID

Prior to claim submission, rendering providers must request and obtain a BCBSMT Provider Record ID. The Provider Record ID associates the provider's rendering NPI with their billing NPI and Tax Identification Number.

Note: Obtaining a BCBSMT Provider Record ID does not automatically activate the BCBSMT provider networks. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.

  • If you do not already have a Provider Record ID established with BCBSMT that matches your billing information (Rendering NPI, Billing NPI and TIN), you will need to complete one of the provider record information forms below (Professional Provider or Facility/Ancillary Provider).
  • Once your Provider Record ID is established, BCBMST will forward you a provider contract/agreement.

Professional Providers

Facilities and Ancillary Providers

  • Complete the application for facility/agency/vendor participation form.
  • Forward completed Provider Record Form to BCBSMT:
    • Email: HCSSPEC@bcbsmt.com (preferred method)
      or
    • Mail to:
      Blue Cross and Blue Shield of Montana
      Network Management Dept.
      P.O. Box 4309
      Helena, MT 59604-4309
  • If you need to check on the status of a previously submitted provider record or have questions regarding the completion of the packet, contact the BCBSMT Network Management Department at 406-437-6100 or via e-mail at HCS-x6100@bcbsmt.com.

If you do not have an NPI, go to the NPPES website to apply for one .


Credentialing Process for Physicians and Professional Providers

Credentialing is the process by which Blue Cross and Blue Shield of Montana (BCBSMT) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards.

All physicians and professional providers must successfully complete the credentialing process prior to participation in the BCBSMT provider networks as outlined in the Provider Network Participation Policy PDF Document.

Effective September 2014, the Council for Affordable Quality Healthcare, Inc. (CAQH) will collect the data required for our credentialing and recredentialing process. CAQH uses an electronic database, entitled ProView, to collect the data. This online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database.

After the BCBSMT Provider Record ID is set up:

  • BCBSMT will roster your name with the Council for Affordable Quality Healthcare, Inc. (CAQH)
  • At any time, you may register online and obtain immediate access to the CAQH ProView online application tool and complete your credentialing application.
  • Provider must authorize BCBSMT to view their credentials. (Only organization(s) the provider authorizes will have access to their data.)
  • CAQH will automatically transmit credentialing information to BCBSMT
  • BCBSMT may need to clarify application details and will contact the provider if necessary.

Note: Providers may utilize CAQH ProView at no cost.

After a completed application is received, BCBSMT verifies the applicant's data. Then, the 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.

When the process is complete, the applicant receives written notification of his/her credentialing status with BCBSMT.

The applicant then receives a second written notification indicating his/her professional status with BCBSMT, the effective date of the contract/agreement and a copy of the executed agreement.

Note: The effective date of the agreement is the credentialing approval date. Effective dates are not backdated.

For more information on the CAQH application process, go to Getting Started with CAQH .

Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following:

  • Right to review information submitted on or with their credentialing and recredentialing application;
  • Right to correct erroneous information;
  • Right to be informed of the status of their credentialing or recredentialing application, upon request.

Applicants should direct all requests to their Network Management Representative. The Enterprise Credentialing Department will notify the Applicant in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be given sufficient time to correct erroneous information and resubmit to the Enterprise Credentialing Department. It will be the Applicant's responsibility to work directly with the reporting entity(ies) to correct the erroneous information.


Credentialing Process for Hospitals and Ancillary Providers

Credentialing is the process by which Blue Cross and Blue Shield of Montana (BCBSMT) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards.

All physicians and professional providers must successfully complete the credentialing process prior to participation in the BCBSMT provider networks as outlined in the Provider Network Participation Policy PDF Document.

After the BCBSMT Provider Record ID is set up, BCBSMT will forward you a contract and a credentialing application. Forward the completed contract and credentialing application along with the requested attachments to BCBSMT via:

After a completed application is received, BCBSMT verifies the data. Then, the Credentialing Committee evaluates the credentials.

When the process is complete, the applicant receives written notification of his/her credentialing status with BCBSMT.

The applicant then receives a second written notification indicating his/her professional status with BCBSMT, the effective date of the contract/agreement and a copy of the executed agreement.

Note: The effective date of the agreement is the credentialing approval date. Effective dates are not backdated.

If you need to check on the status of a previously submitted provider record or have questions regarding the completion of the packet, contact the BCBSMT Network Management Department at 406-437-6100 or via e-mail at HCS-x6100@bcbsmt.com.

If you do not have an NPI, go to the NPPES website to apply for one .


Getting Started with CAQH

First Time Users (If you are not registered with CAQH)

Follow These 5 Easy Steps:

  1. Register with CAQH ProView
  2. Complete the online application and review the data for accuracy and completeness
  3. Authorize BCBSMT access to the information
  4. Verify the data and attest to it
  5. Upload the supporting documents

Note: Registration and completion of the online application is free.

Existing CAQH Users

If you have already registered your CAQH Provider ID and completed your online application through your participation with another health plan, log into the CAQH ProView  database and add BCBSMT as one of the health plans that can access your information.

Review to ensure your information and supporting documents are accurate and current, and reattest if necessary.

Note: Please ensure that your primary address is noted as your Montana location.


Completing the Application Process

The CAQH standardized application is an online form that meets the needs of all participating health care organizations. When completing the application, you will need to indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through ProView maintained by CAQH in a secure, state-of-the-art data center. When you are ready to begin entering your data, log in to CAQH ProView  with your user name and password.

The following materials are helpful to reference while applying:

  • Previously completed credentialing application
  • List of previous and current practice locations
  • Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc.)
  • State medical license(s)
  • Drug Enforcement Administration (DEA) Certificate
  • IRS Form W-9(s)
  • Malpractice insurance face sheet
  • Summary of any pending or settled malpractice cases
  • Curriculum Vitae

After completing the online credentialing application, you will also be asked to:

  1. Authorize access to your information — List the organizations that you would like to receive your information. You may select "BCBSMT" or "global authorization."
  2. Verify your data entry/Attest — Review the summary of your data for accuracy and completeness, and make any necessary changes.
  3. Upload supporting documents — Fax the applicable documents required to complete your application to CAQH at 866-293-0414.
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Malpractice insurance face sheet with provider's individual name listed
    • Summary of any pending or settled malpractice case(s)
    • Signed Attestation (page 18 of online application — print and sign)

Additional Information Required by BCBSMT for Credentialing

Physicians (MDs and DOs): If you do not have current admitting privileges, provide a formal letter signed by the physician or a physicians group who have agreed to admit and care for your patients as necessary is required. Admitting physicians must be the same specialty, located in the practicing physician's community, and provide 24/7 coverage.

At recredentialing physicians must attest to having completed 75 Category I CME in the previous 3 years.

If you have any questions on accessing the CAQH ProView, you may contact the CAQH Help Desk at 888-599-1771 or providerhelp@solutions.caqh.org for assistance.

Note: BCBSMT may contact you to supplement, clarify or confirm certain responses on your application. Therefore, you may be required to submit additional documentation in some situations, in addition to the information you submit through the CAQH ProView database.


CAQH Contact Information

Explore the CAQH website  for more information about the CAQH ProView database and the application process.

View the CAQH Provider and Practice Administrator Quick Reference Guide  PDF Document.

CAQH Contact Information

Help Desk: 888-599-1771

Help Desk Email Address: providerhelp@solutions.caqh.org

Online Application System 


Credentialing Updates

Keeping your information current with CAQH and BCBSMT is your responsibility.

CAQH UPD Database

You will be sent automatic reminders from CAQH to review and attest to the accuracy of your data. Use the CAQH database  to report any changes to your practice.

Note: You must enter your changes into the CAQH database for BCBSMT to access during the credentialing and recredentialing process. Only health plans that participate in the CAQH database that you have authorized access will receive any changes.

BCBSMT Provider File Updates

BCBSMT members rely on the accuracy of the provider information in our online Provider Finder. This is why it's very important that you also inform BCBSMT of changes to your practice. If you are a participating provider with BCBSMT, you may request most changes online by using the online Provider Data Update Notification Form.


Recredentialing

Recredentialing is performed every three (3) years.

The process of recredentialing is identical to that for credentialing.

If you are an existing user of CAQH, you are required to review and attest to your data once every four (4) months.

  • At the time you are scheduled for recredentialing, BCBSMT will send your name, via its roster, to CAQH to determine if you have already completed the UPD credentialing process and authorized BCBSMT or selected "global authorization." If so, BCBSMT will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you.
    • Keeping your information current will eliminate recredentialing notices from being sent to you.
  • If your credentialing application (for recredentialing) is not available to BCBSMT through CAQH because you have not completed the CAQH credentialing process — CAQH will mail you a welcome kit that includes access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the CAQH database via the Internet to complete and submit your application.