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For Health Professionals

Join Our Network

NOTE: Providers Participating with Capital Blue Cross, log into NaviNet
Go to the CBC Network Resource Center

  • Provider Library
  • Forms, Guides, and Directories
  • Professional Provider Information Exchange Forms

Medical Professional and Ancillary providers are invited to submit a request to participate in our networks.  All participation requests are reviewed to ensure member access to care is fulfilled by our Networks.

Providers should not schedule services with Capital BlueCross members until they have received written notification from Capital BlueCross advising:

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

Claims submitted prior to this effective date will be processed as out of network, resulting in payments being directed to the member with appropriate cost sharing amounts.

Confirm your location is within our 21 county service area. If your practice address is within our service area, you are eligible to complete our credentialing application and request participation in the Capital BlueCross Networks.

Contracting Process

You must have a Capital BlueCross executed contract to become a participant in our Networks. After we receive the appropriate forms, as outlined below, we will send a packet of contracting materials.

Credentialing Process

Capital BlueCross participates with the Counsel for Affordable Quality Healthcare’s (CAQH) Universal Credentialing.

  • Do you currently have a CAQH Provider number?
    1. To participate with CAQH UPD, all you have to do is sign into the CAQH website, and create, at no charge, a comprehensive ‘Provider Profile’ (CAQH Credentialing Application) to share with Capital BlueCross.
    2. Please remember to give Capital BlueCross permission to have access to your application.

To join the Keystone Health Plan® Central and SeniorBlue® PPO and SeniorBlue® HMO Networks, contact Magellan Behavioral Health®, Inc. at 1.800.866.4108. 

To join our CAIC/CAAC Network (Traditional, PPO, and POS), complete all fields on the forms below.  Failure to complete the forms in their entirety will result in a delay to the contracting process. Please email or fax to:

To join the Capital BlueCross CAIC/CAAC network which includes Traditional, PPO, POS and SeniorBlue PPO networks, contact American Specialty Health Group, Inc. at 1.800.972.4226.

To join our Keystone Health Plan Central and SeniorBlue HMO, complete the attached forms below. Failure to complete the forms in their entirety will result in a delay to the contracting process. Please email or fax to:

Provider Data Form

EFT Enrollment Form

W9 – Taxpayer Identification Form

When requesting participation in the KHPC Network (HMO product), please complete all fields on the forms below.  Failure to complete the forms in their entirety will result in a delay to the contracting process. Please email or fax to:

To join all products -

  • CAIC/CAAC Network (Traditional, PPO, and POS)
  • SeniorBlue PPO
  • KHPC (HMO product)
  • SeniorBlue HMO

Please complete all fields on the forms below.  Failure to complete the forms in their entirety will result in a delay to the contracting process. Please email or fax to:

 

To join our CAIC/CAAC Network which includes Traditional, PPO, POS, Keystone Health Plan® Central, SeniorBlue® PPO and/or SeniorBlue® HMO Networks, complete all fields on the forms below.  Failure to complete the forms in their entirety will result in a delay to the contracting process. Please email or fax to:

Provider Data Form for facility/ancillary providers

Provider Surveys Please select and complete the survey below that best describes your provider type.

On behalf of Capital BlueCross, Magellan Healthcare, Inc. assists in the administration of behavioral health benefits. Magellan Healthcare, Inc. is an independent company.

On behalf of Capital BlueCross, American Specialty Health Group, Inc. assists in the administration of chiropractic benefits. American Specialty Health Group, Inc. is an independent company.