Established Providers - Recredentialing
Is it time for you to go through the recredentialing process? Download and complete the credentialing update form, then fax along with required documentation to 803-870-9997 or email to RECRED.APP@bcbssc.com.
- South Carolina Uniform Managed Care Practitioner Credentials Update Form (If recredentialing is 30 or more days past due, initial enrollment is required.)
- Copy of state license(s)
- Copy of current DEA Registration, if applicable
- Copy of current malpractice insurance/COI (must be a minimum of $1MM/$3MM)
- Clinical Laboratory Improvement Amendment (CLIA) Certification Verification Form. The form should be completed based on the entity/practice, and included with the individual’s application. A separate form is required for each location where the provider renders services.
- CLIA Certificate(s) for each location where laboratory services are performed
Additional Documentation for Healthy BlueSM Recredentialing
Disclosure of Ownership Form — The form should be completed based on the entity/practice and included with the individual’s application. A separate form is required for each location where the provider renders services.