December 2019
Provider Credentialing Rights and Responsibilities
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 their credentialing or recredentialing applications, upon request.
Applicants should direct all requests to NetOps Provider Updates. The Enterprise Credentialing Department will notify the applicant in writing if we discover wrong information during the verification process from any primary source. We will give applicants 30 calendar days to correct wrong and/or conflicting information and resubmit to the Enterprise Credentialing Department, your assigned Provider Network Consultant or the Medical Director. It will be the applicant’s responsibility to work with the reporting entity to correct the wrong and/or conflicting information.
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 BCBSIL HMO, PPO, Blue Choice PPOSM, Blue Cross Medicare Advantage (PPO)SM, Blue Cross Medicare Advantage (HMO)SM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. Effective Jan. 1, 2019, 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 (BCCHPSM) Medicaid plan.