Provider credentialing process

Quick reference guide

What is the general process that Capital Blue Cross follows to credential providers?

  1. The Contracting department receives the request.
  2. Within five business days of receipt of all completed credentialing materials, Contracting processes the request and sends it to the Credentialing department.
  3. Within three business days, Credentialing requests the Counsel for Affordable Quality Healthcare (CAQH) application and assigns the task to the team. (CAQH is the company that maintains the universal credentialing application that Capital Blue Cross uses.)
  4. The Credentialing team works the task in five to seven business days.
  5. If the task came in via Availity, Credentialing will complete the task in Business Process Manager (BPM is the software application that Capital Blue Cross uses to process providers’ credentialing requests) within seven business days of receipt. During peak times this time could possibly be extended beyond the seven business days of receipt and will depend on the volume of requests received. Once Credentialing has completed their task, the request will move to the Contracting queue and will sit in this queue until Contracting completes their task. If the task did not come in via Availity, upon completion of the task, Credentialing will send an email to the Contracting Dept. noting those that have been credentialed and the effective date.
  6. Once Contracting and Credentialing mark the BPM task as complete, the system updates in real-time.
    • If the request fails for a system edit, it will go to the Provider Data team for review. Provider Data will work the task within five business days and either complete the update or return for missing information.

Exception:

If a provider is flagged in Credentialing and needs to be reviewed by the committee for approval, this will add an additional 30 days to the process.

Need additional information?

Detailed credentialing process information is included in the Capital Blue Cross Provider Manual, located on our provider portal, Availity. For CAQH assistance or questions, please call 888.599.1771.