Provider Enrollment Frequently Asked Questions
Here you can find some questions we've received from the provider community about provider enrollment. If you have a question you would like to submit please contact us.
How far in advance of a provider signing with our practice should I submit the application?
As soon as you have a complete enrollment application you can start the process. We are able to give a future enrollment date. For example, you can start the enrollment process now for a location or provider starting months down the road.
Is the facility of the provider notified when it is time for recredentialing?
We send re-credentialing letters to physicians. If a facility has a designated department or contact person that handles credentialing on file, we send the notification there. If a credentialing vendor is designated (e.g., EmCare) our credentialing area will contact the vendor. If the proper contacts are not receiving these letters, please update your contact information with us.
Are nurse practitioners (NPs) also required to complete the Education/Training/Hospital Privileges section of the New Provider Enrollment Application?
Yes, NPs should complete this section. Mark if the section is not applicable. If there are no hospital privileges, note the provider will call 911 in an emergency.
Do BlueCross BlueShield of South Carolina and BlueChoice HealthPlan recognize providers working under locum tenens?
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 tenens 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 provider credentialing needs to affiliate, credential, etc., as we would a provider joining that practice.
When does the provider effective date begin?
The effective date for networks begins upon completion of the contract review. We base the BlueCross and BlueChoice® effective date (date we add the provider to the file) on the signature date on the provider's application.
What is the difference between individual enrollment and group enrollment? How does this impact a non-participating provider in a participating group?
The Provider Enrollment department only handles the individual network enrollment process. Our Provider Contracting area negotiates group contracts for BlueCross networks. You should contact your Provider.Directory@bcbssc.com for clarification about group enrollment.
If I am a mental health provider, should I go through the enrollment process for both BlueCross and Companion Benefit Alternatives, Inc. (CBA)?
You will not need to complete the enrollment process for BlueCross. Enrollment for mental health practitioners is coordinated through CBA and covers the networks for the CBA, Preferred Blue®, BlueChoice and the State Health Plan networks. CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueCross and BlueChoice.
How long does the enrollment process take once I submit all required documentation?
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.
Whom should I contact if I have a question about the status of my provider enrollment application?
For BlueCross and BlueChoice provider credentialing status questions, please fill out this form. You can email CBA at cba.provrep@companiongroup.com for questions about mental health provider credentialing.
What provider enrollment form should I use when I have sold the practice to a new physician owner?
You should submit the Application for Group/Clinic/Institution Enrollment.
What is the process if I am already enrolled and affiliated with a facility and want to be affiliated with another separate facility? What documentation do you require?
You will need to submit the Request to Add Practitioner Affiliation form, the Authorization for Clinic/Group to Bill for Services and the Appendix D and Hold Harmless forms if the group participates with BlueChoice.
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 enrollment process.
Does BlueCross use a separate vendor for credentialing (i.e., Council for Affordable Quality Healthcare)?
BlueCross does not use any vendor for provider enrollment or updates. We use our own credentialing department for provider verifications to meet the National Committee for Quality Assurance (NCQA) credentialing standards.
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 credentialed if I am missing South Carolina licensure?
No. You must have South Carolina licensure to be enrolled with BlueCross.
BlueChoice® HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.