Español
Navigate to Facebook Navigate to Twitter
Log in or Register as new user  

For Health Professionals

Join Our Network

Medical Professional, Ancillary and Facility 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.

Please refer to the link below to determine if the network for your provider type is open for participation.

The following professional provider networks have limitations to participation:

Behavioral Health

Our Capital BlueCross 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)

Chiropractic

  • Chiropractic

Our Keystone Health Plan Central® and BlueJourney® HMO network is closed to new providers, except for existing providers opening a solo practice.

All Other Professional Providers

  • Audiology
  • Cardiology
  • Dietician/Nutritional Counseling
  • OB/GYN
  • Podiatry
  • PT/OT
  • Speech Pathology
  • Optometry/Ophthalmology

Our Capital BlueCross network (Traditional, PPO, and POS) and Keystone Health Plan® Central and BlueJourney® HMO network is closed to new providers, except for existing providers opening a solo practice.


Network Service Area

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

Contracting Process

Executed Capital BlueCross contracts are required for participation in our Networks. After receiving the appropriate forms as outlined below, a packet of contracting materials will be e-mailed to the correspondence contact provided.

Capital BlueCross also requires contracted providers to enroll in Electronic Funds Transfer (EFT), NaviNet®, and Electronic Remittances within 90 days of the executed contract date with Capital BlueCross.

Credentialing Process

Capital BlueCross participates with the Counsel for Affordable Quality Healthcare’s (CAQH) Universal Credentialing. Any professional provider interested in participating in our network is required and must complete the Council for Affordable Quality Healthcare’s (CAQH) online credentialing application: CAQH ProView™. If you do not have access you may sign into the CAQH website, and create, at no charge, a comprehensive ‘Provider Profile’ (CAQH Credentialing Application) to share with Capital BlueCross. Please remember to give Capital BlueCross permission to have access to your application.

What Happens Next?

After processing your request, you will receive correspondence from Capital BlueCross Provider Support Services department to notify you of the outcome.

Providers are not to 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.

Select the provider type that best represents your practice

This professional provider network has limitations to participation. Please verify our closed network list before proceeding.

To join the Keystone Health Plan®Central and BlueJourney® PPO and BlueJourney®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:

This professional provider network has limitations to participation. Please verify our closed network list before proceeding.

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

This professional provider network does not have limitations to participation.

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 see below:

When requesting participation in the Keystone Health Plan®Central and BlueJourney® HMO, please complete all fields on the forms below.

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:

When requesting participation in the Keystone Health Plan®Central and BlueJourney® HMO, please complete all fields on the required forms below.

 

This professional provider network has limitations to participation. Please verify our closed network list before proceeding.

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 see below.

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, BlueJourney® PPO and/or BlueJourney® HMO Networks, complete all fields on the forms below.

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

Failure to complete the forms in their entirety will result in a delay to the contracting process.
**Please note, this form is an inquiry for consideration and not an official registration.


Please email or fax to:

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.