How to Get Credentialed

Practitioners

Practitioners can submit information online using the Council for Affordable Quality Healthcare® Universal Provider Datasource®. Blue Cross Blue Shield of Michigan and Blue Care Network use the information you submit to enroll and credential you, reducing the time and hassle of paperwork. 

Find out more about UCD at CAQH.org

To begin the process, click on the enrollment link to locate and submit the proper form.

Credentialing and recredentialing tips

To help us expedite the credentialing and recredentialing processes, make sure you take the following actions:

1. Update your information with the CAQH UPD, including your current mailing address. 
2. Reattest with CAQH every 120 days. 
3. Keep board certification information current at all times. 
4. Designate your primary specialty on the CAQH UPD with care as the primary specialty: 
   • Determines whether the physician is designated as a primary care physician or a specialist for managed care networks*
   • May affect the way claims are processed and paid
   • Is reflected in our online provider directories 
5. Require your malpractice carrier to submit your liability insurance information in a timely manner. Forward the following Professional Liability Verification Form and Authorization for Release of Information Form to your current insurance carrier(s).The Professional Liability Verification Form must be completed by your insurance carrier and returned to the fax number provided on the form.
   
   • Professional Liability Verification Form (PDF)
     
   • Authorization for Release of Information Form (PDF)
     
6. If you are affiliated with a practitioner group delegated to perform credentialing, require that they send in your completed credentialing profile as soon as you are due for recredentialing. 
7. Request that residents wait to submit their applications until May in order to avoid up-front denials when minimum criteria have not been met. 
8. Be sure to sign and include all required signature documents. 

If you have any questions regarding our enrollment or credentialing processes, call our Provider Enrollment and Data Management department at 1-800-822-2761*.

Credentialing updates

Practitioners currently being credentialed or recredentialed may request the status of their application by contacting the Provider Enrollment and Data Management department at 1-800-822-2761**.

* Specialties eligible for participation as a primary care physician include family medicine, general practice, geriatric medicine, internal medicine, pediatrics and preventive medicine.

** Effective Apr. 1, 2012, you need the following three items ready when you call Provider Enrollment and Data Management:

• National Provider Identifier (the NPI of the provider related to your question) 
• Tax ID/Social Security number (the last four digits of the provider's Social Security number (for an individual provider) or tax ID (for a group) for any providers currently contracted with the Blues) 
• Primary address and phone number (to verify the provider's primary address and phone number for any provider currently enrolled with BCN or BCBSM)