Join our network

Find your specialty and apply to join our network. Check to ensure your practice is in our 21-county service area.

Select your practice type

Behavioral health professional providers

This network is open only to groups containing psychiatrists and those who provide autism services.

To join our network, fully complete and email or fax the forms below to us:

Email address and fax number:

Facility/ancillary providers

Laboratories

Avalon Healthcare Solutions, LLC is Capital BlueCross’ laboratory benefits manager. Effective 1/1/19, Capital BlueCross will no longer accept direct independent lab network participation requests. To join Avalon Healthcare Solutions’ network of independent labs and serve Capital BlueCross members, please send inquiries to: Avalon-Providers@Avalonhcs.com.

Other professional provider types

To join the Capital BlueCross CAIC/CAAC network, which includes Traditional, PPO, POS BlueJourney PPO (Medicare Advantage), as well as the Keystone Health Plan Central (HMO product) and BlueJourney HMO (Medicare Advantage) network, please fully complete and fax or email these forms to us:

Email address and fax number:

Dental Providers – Please visit BlueCross Dental to learn more about joining the Capital BlueCross CAIC/CAAC network.

Primary care physicians (PCP's), internal medicine PCP's, pediatric PCP's

To join the Capital BlueCross CAIC/CAAC network, which includes Traditional, PPO, POS BlueJourney PPO (Medicare Advantage), as well as the Keystone Health Plan Central (HMO product) and BlueJourney HMO (Medicare Advantage) network, please fully complete and email or fax these forms to us:

Email address and fax number:

Contracting process

Contracts are required for participation in our networks. We will mail contracting information to you after we receive your forms.

We require contracted providers to enroll in electronic funds transfer (EFT), Availity Provider Portal, and electronic remittances within 90 days of the contract date with Capital BlueCross.

Credentialing process

We participate with the Counsel for Affordable Quality Healthcare’s (CAQH) Universal Credentialing. Professional providers interested in participating in our network are required to complete the Council for Affordable Quality Healthcare’s (CAQH) credentialing application: CAQH ProView™. If you do not have access you may sign into the CAQH website, and create a comprehensive ‘Provider Profile’ (CAQH Credentialing Application) to share with us. Please remember to give Capital BlueCross permission to access your application.

What happens next?

You’ll receive information from us after we process your request.

Please do not schedule services with Capital BlueCross members until you have written notification from Capital BlueCross advising:

  • The provider has successfully completed the credentialing requirements
  • The effective date of participation in our network(s)

If a claim is submitted prior to the network participation effective date, it will be processed as out of network. Payments will be sent to the member with appropriate cost sharing amounts.

These networks have limitations:

Closed networks

Behavioral health

Our network (Traditional, PPO, and POS) is closed to the following providers, except for existing providers opening a solo practice.

  • social worker (unless treating autism)
  • licensed professional counselor (unless treating autism)
All other professional providers
  • audiology
  • cardiology
  • dietician/nutritional counseling
  • obstetrician-gynecologist
  • podiatry
  • physical therapy/occupational therapy
  • speech pathology
  • optometry/ophthalmology

Our Traditional, PPO, POS, Keystone Health Plan Central and Medicare Advantage HMO networks are closed to new providers, except for existing providers opening a solo practice.

Facility/ancillary providers
  • home health
  • hospice
  • skilled nursing facility

Our Traditional, PPO, POS, Keystone Health Plan Central and Medicare Advantage HMO networks are closed to new ancillary providers.

1This network is closed. If you provide specialized home medical equipment services, please email the specific specialized services.

2This network has limitations. Please identify specific, specialized services on the Facility Provider Application.