When does the provider effective date begin – upon the signature date of the provider contract or upon completion of the provider credentialing review date?
The provider's effective date is the date the enrollment application is approved and finalized. We do not backdate enrollments due to URAC requirements.
What are the differences between individual credentialing and group credentialing?How does this impact a non-participating physician in a participating group?
Both the group and the individual must be enrolled to be considered in network. If you have any questions about enrollment, please fill out the Provider Enrollment Assistance Form.
If I am a mental health provider, should I go through the credentialing process for both BlueChoice® and Companion Benefit Alternatives (CBA)?
You will not need to complete the credentialing process for BlueChoice. Credentialing for mental health practitioners is coordinated through CBA. CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueChoice.
How long does the credentialing process take once I submit all required documentation?Why do I have to supply the date I submitted the application to find out my enrollment status?
The 90-day review period begins after we receive all required documentation. If an application is missing information or if the application is incomplete, we pend the application and the Provider Enrollment department will request the information from you. Once we receive the information, we send the application to review.
Who should I contact if I have a question about the status of my provider enrollment application?
Am I required to be accredited with a professional association of my specialty (i.e., American College of Radiology)?
No, this is not a requirement for our provider credentialing process.
Does BlueChoice use a separate vendor for credentialing (i.e., Council for Affordable Quality Healthcare)?
BlueChoice does not use any vendor for provider credentialing. We use our own department for provider verifications to meet the National Committee for Quality Assurance (NCQA) credentialing standards.
How long is the enrollment process?
Provider enrollment has a 90-day review period to process applications. It may be prolonged, however, based on the completeness of the application. If we require additional information, this will extend the enrollment process.
If a physician is licensed and affiliated with a participating practice but not yet enrolled with BlueChoice, can the physician see patients?
The providers can see patients. We do, however, ask that providers do not see patients until they are fully enrolled, as this could cause patients to be liable for out-of-network costs and the provider to not be paid.
How often is recredentialing required?
Providers go through the recredentialing process every three years. Per the Center for Medicare and Medicaid Services (CMS) mandate, however, you may hear from your provider advocate to verify that your practice and physician information is up to date on an annual basis. You should respond to these requests to ensure your information is current and accurate.
Can I be enrolled if I am missing South Carolina licensure?
No. You must have South Carolina licensure to be enrolled with BlueChoice.
How far in advance of a physician signing with our practice should I submit the application to BlueChoice?
As soon as a provider knows he or she will require enrollment services — such as a new provider or new location — the better it is to notify us at that time. We are able to give a future date for an application received. For example, a provider can start the enrollment process now for a provider adding a new location months later.
Is the facility or the physician notified when it is time for re-credentialing? The facility never receives a letter about a physician that is due to be re-credentialed.
We send re-credentialing letters to physicians. If a facility has a designated department or contact person that handles credentialing, we send the notification there. If a credentialing vendor is designated (i.e., EmCare) our credentialing area will contact the vendor. If the proper contacts are not receiving these letters, please update your contact information with us.
When a provider leaves a practice, do BlueCross BlueShield of South Carolina and BlueChoice note the separation date as the practitioners' last day of employment or the date the application was received? Our concern is there are claims pending they will be denied.
We terminate a provider one day beyond the required (requested) termination date. Any claims submitted for dates of service prior to the provider leaving will be processed for payment.
Are nurse practitioners (NPs) also required to complete the credentialing application Education/Training/Hospital Privileges?
Yes, every section should be filled out either with accurate information or notating the section is not applicable.
Do BlueCross and BlueChoice recognize physicians working under Locum Tenen?
We permit practitioners to work in this capacity for three months or less. The provider group must take responsibility to be sure the practitioner who is under Locum Tenen has the appropriate credentials/experience, etc. to perform the procedures assigned to him. If the practitioner will be working with the practice for more than three months, then the provider needs to be enrolled.
BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.