Through the credentialing process, we review and validate the professional qualifications of physicians and certain other providers who apply for participation in our networks. This process ensures that providers meet our professional standards.
For Medicaid providers: There is a separate credentialing process for Illinois Medicaid plans. The state of Illinois is responsible for credentialing and recredentialing of physicians and certain other providers who participate in the Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Medicaid plans. To be eligible to participate, providers must be enrolled/credentialed through the Illinois Medicaid Program Advanced Cloud Technology system. For more information, visit the IMPACT website. Providers with general questions about IMPACT or provider enrollment may email IMPACT Help or call 877-782-5565 (select option #1).
Credentialing Process
We use information from the CAQH Provider Data Portal to support the credentialing process.
The CAQH Provider Data Portal allows providers to self-report professional and practice information to BCBSIL. If you don’t have a CAQH account already, you’ll need to register.
Quick Tips
- Complete all application questions.
- Ensure all sections of the application are complete and accurate.
- Authorize BCBSIL so we can access your credentialing information.
- Attest to your data profile.
- Upload supporting documentation.
Refer to the CAQH Provider Data Portal for Providers User Guide for additional information.
BCBSIL may contact you to supplement, clarify or confirm certain responses on your application. You may be required to submit additional documentation in some situations, in addition to the information you submit through the CAQH Provider Data Portal.
Data Verification
We’re working with Verisys to verify your credentialing data after you enter it into the CAQH Provider Data Portal. Verisys may contact you on behalf of BCBSIL and request that you:
- Re-attest to your data’s accuracy, or
- Complete your credentialing application by entering or attaching missing information in CAQH Provider Data Portal
Please respond as soon as possible to help complete the credentialing process. You’ll receive written notification of your status when the credentialing process is completed.
Credentialing Updates
Keeping your information current is your responsibility, and you must do so with CAQH and BCBSIL.
CAQH will send you automatic reminders to review and attest to the accuracy of your data. Use the CAQH Provider Data Portal to report any changes to your practice, in accordance with the time frames outlined in the state of Illinois Health Care Professional Credentials Data Collection Act, as follows:
- Within five business days for state health care professional license revocation, federal drug enforcement agency license revocation, Medicare or Medicaid sanctions, revocation of hospital privileges, any lapse in professional liability coverage required by a health care entity, health care plan or hospital, or conviction of a felony.
- Within 45 days from the date you knew of the change, for any other information provided on your credentialing application, i.e., practice address, hospital affiliation, etc.
You must enter your changes into the CAQH Provider Data Portal for us to access during the credentialing and recredentialing process. Only the health plans that participate in the CAQH Provider Data Portal and for which you have authorized access will receive any changes.
Update BCBSIL of information changes
It is important that you also inform BCBSIL of changes to your practice or demographic information. Learn more on our Verify and Update Your Information page.
Check Credentialing Status
To check the status of your credentialing process, enter your NPI or license number in our Credentialing Status Checker.
Recredentialing
CAQH requires you to review and attest to your data once every six months. BCBSIL recredentials network providers every three years in accordance with state of Illinois requirements. The state selected the last digit of the physician's Social Security number to create the single cycle.
At the time you are scheduled for recredentialing, BCBSIL will add you to the CAQH roster to receive your application. If your application is expired or missing information, CAQH will contact to update your information. You will continue to receive recredentialing notices up to and including notice of termination of participation.
We work with Verisys to verify credentialing and recredentialing data. Verisys may contact you on our behalf and ask you to re-attest to your data accuracy.
Once the recredentialing process is completed, you are considered approved unless otherwise notified. If not approved, a letter with details will be mailed within 10 business days.
Provider Rights
Providers applying or reapplying for participation or continued participation in 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 and/or conflicting information;
- Right to be informed of the status of their credentialing or recredentialing application, upon request.
Our credentialing department will notify applicants in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be granted 30 calendar days to correct erroneous and/or conflicting information and resubmit to our credentialing department, the assigned Provider Network Consultant or the Medical Director. It is the applicant’s responsibility to work directly with the reporting entity to correct the erroneous and/or conflicting information.
