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Provider Credentialing Rights and Responsibilities

Posted May 31, 2018

Applicants applying or reapplying for participation or continued participation in Blue Cross and Blue Shield of Illinois (BCBSIL) networks* have the right to review information submitted to support their credentialing application and receive the status of your credentialing or recredentialing application, upon request.

The Enterprise Credentialing Department will notify the applicant in writing if erroneous information is discovered during the verification process from any primary source. Provider applicants have the responsibility to work directly with BCBSIL to correct erroneous information and/or conflicting information within 30 calendar days. All corrections must be submitted in writing to our Enterprise Credentialing Department, your assigned Network Management Consultant or the Medical Director to avoid future delays in processing your information for consideration in BCBSIL networks.

Mail:

Enterprise Credentialing Department

1001 E. Lookout Drive

Richardson, Texas 75082

Fax: 972-766-2137

Email: CredentialingCommittee@bcbstx.com

Please Note: Credentialing decisions will not be made until the applicant has responded or if the response has exceeded the 30 calendar days allocated.

Applicants who only see patients in an office setting and do not have hospital admitting privileges at a network hospital may attest to having coverage for hospital admissions by submitting a signed Hospital Coverage Letter

This article applies to PPO, Blue Choice PPOSM, HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare DirectSM and Blue FocusCareSM, Blue Cross Medicare Advantage (PPO)SM, Blue Cross Medicare Advantage (HMO)SM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. Effective Jan. 1, 2018, the State of Illinois is responsible for credentialing and recredentialing of physicians and certain other providers that participate in the Blue Cross Community Health PlansSM (BCCHP) Medicaid plan.