Facility providers include hospitals, home health agencies, skilled nursing facilities and free-standing surgical centers. All types of facilities providing mental health and substance abuse services are also included. Mental health and substance abuse services may be in inpatient, residential or ambulatory settings.
In some cases, a site visit will be required.
Credentialing applications are reviewed by the Medical Director and/or the Credentialing Committee on a regular basis. All credentialing decisions will be communicated in writing.
The credentialing criteria serve as the foundation for determining a provider’s eligibility and continued eligibility in all Blue Cross networks. Providers are expected to remain in compliance with credentialing criteria at all times. For more information, please refer to series 1400 in the Credentialing Policy Manual (PDF).