Welcome to Blue Cross Blue Shield of Wyoming (BCBSWY)! We are pleased that you are considering becoming one of our participating providers. The following pages contain some basic guidelines about our credentialing process.
What is credentialing?
The credentialing process allows us to review, evaluate and approve (or disapprove) a provider to participate in our network(s). This ensures that each network provider is qualified by education, training, licensure and experience to deliver quality healthcare services to our members.
Who needs to be credentialed?
The credentialing process needs to be completed by all providers who wish to provide covered healthcare services to our members and are requesting network participation with BCBSWY. This includes:
- Facilities (including acute care hospitals, skilled nursing and surgical centers),
- Licensed and independent practitioners.
Types of individual providers that are required to be credentialed include, but are not limited to:
- Advanced Practice Registered Nurse (CNM, CNP, CRNA, CNS)
- Certified Diabetic Educator
- Licensed Addiction Counselor
- Licensed Independent Certified Social Worker
- Licensed Professional Clinical Counselor
- Licensed Registered Dietitian
- Occupational Therapist
- Physical Therapist
- Physician Assistant
- Speech/Language Therapist
What are our credentialing criteria?
To qualify for network participation, applicants are required to meet the following criteria, as applicable:
- Submit a fully completed, signed application to BCBSWY.
- Maintain staff appointment in a network hospital or facility, as applicable.
- Possess required education from an appropriately accredited school.
- Successful completion of post graduate residency training or specialty board certification, as applicable.
- Possess a valid, active license, DEA and controlled substance registration in the state of Wyoming, as applicable.
- Have the required levels of individual professional liability coverage.
- Be free of conviction for any criminal offense punishable as a felony, or engagement in any improper act related to the qualifications, functions or duties of a provider.
- Maintain absence of Medicare/Medicaid sanctions, fines or suspensions from either program.
When is credentialing performed?
Completion of the credentialing process is required prior to a provider participating in our network(s). Participation with BCBSWY cannot be dated prior to approval of the credentialing application.
What is re-credentialing?
At minimum, BCBSWY conducts re-credentialing of each participating provider at least every three (3) years. In the third year of the credentialing cycle, BCBSWY requests providers complete a re-credentialing application that requires providers to update information and elements that are subject to change and need to be re-verified.
How do I start the credentialing process?
In order to begin the credentialing process please:
- Contact BCBSWY to request an application.
- Review the credentialing criteria in this document.
- Complete the credentialing application and attach all required materials.
- Return the application to BCBSWY as instructed.
What happens next?
- When your credentialing application is received by BCBSWY, our credentialing staff will review it for accuracy and completeness.
- Our credentialing staff will then conduct a Primary Source Verification (PSV) of the following information:
- License(s) in noted profession(s)
- Board Certification, if applicable
- Education at highest level and Training
- Sanction activity, restrictions on license (limitations on scope of practice)
- Medicaid/Medicare Sanctions
- NPDB & HIPDB
- After the PSV is complete, applications are forwarded to the BCBSWY Credentialing Committee for approval (or disapproval).
- Once a credentialing determination has been made regarding an application submitted by a provider, BCBSWY notifies the provider.
If approved, the provider is sent an approval notification letter that includes information on the preparation of their contract, website link to the Provider orientation materials, and contact information for the Provider Relations department to seek guidance or technical assistance as needed.
If denied, a provider is sent a denial notification letter as well as contact information for the BSBSWY staff to address questions.
It is our goal to complete the credentialing process for clean applications within 30 days.
Who can I contact for assistance?
Our Provider Relations staff is available to answer questions about the credentialing process. You may contact us by email at firstname.lastname@example.org or by calling 888-666-5188.
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