Recredentialing

The process of recredentialing is identical to that for credentialing and is consistent with NCQA and State of Texas requirements.

Existing CAQH users

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, BCBSTX will send your name, via its roster, to CAQH to determine if you have already completed the CAQH ProView credentialing process and authorized BCBSTX or selected “global authorization”. If so, BCBSTX will be able to obtain current information from the CAQH ProView database and complete the recredentialing process without having to contact you. Refer to the list of CAQH Approved Provider Types List .

Provider Types not listed on CAQH list

If your credentialing application (for recredentialing) is not available to BCBSTX through CAQH because

1. you have not completed the CAQH ProView 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 ProView database via the Internet to complete and submit your application,

or

2. you are a physician or other professional provider who does not have a provider type listed in the CAQH Approved Provider Types list , you must go to the TDI website  to access and complete a Texas Standardized Credentialing Application, and fax or mail the completed application along with the required supporting documents referenced below:
   • State medical license(s)
   • Drug Enforcement Administration (DEA) Certificate
   • Malpractice insurance face sheet
   • Summary of any pending or settled malpractice case(s) - if within 10 or less years old
   • Curriculum Vitae
   • Signed Attestation (page 18 of online application – print and sign)
   • Written Protocol (Nurse Practitioners only)

Forward completed application packet to BCBSTX:

Fax to: 972-996-8230 (preferred method)
or
Mail to:
Blue Cross and Blue Shield of Texas
Attn: Provider Administration
P.O. Box 65067
Dallas, TX 75265-0267

Recredentialing Decision Notification

Upon completion of the recredentialing process, providers are considered approved unless notified otherwise. Notifications of the determinations other than approval will be mailed within 10 business days of the decision.

Additional Forms Required by BCBSTX for Recredentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete and forward by fax or mail to BCBSTX as indicated above.

• Hospital Coverage Letter  – required to be submitted to BCBSTX for those providers who do not have admitting privileges at a participating network hospital.
• Behavioral Health Form  – required to be submitted to BCBSTX for all Behavioral Health Providers.