Board Certified & Non-Board Certified:
- Doctor of Dental Surgery
- Doctor of Maxillofacial Surgery
- Doctor of Medical Dentistry
- Doctor of Osteopathy
- Doctor of Podiatry
- Medical Doctor
Please include the following documents with your application:
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites.
Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS) – we will accept a site survey conducted within the past 3 years.
Please include the cover letter and follow-up letter (if applicable):
Please include the following documents with your application:
Please include the following documents with your application:
Please include the following documents with your application:
Please include the following documents with your application:
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Non accredited Pharmacies must submit exemption letter from Medicare.
One of the following accreditation certificates is needed if no exemption letter from Medicare:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc's "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification/Accreditation International (BOC)
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Blue Medicare HMO and Blue Medicare PPO networks only.
Please include the following documents with your application:
A copy of a NC license or Certificate of Need (if applicable per state or federal regulatory requirements)
One of the following accreditation certificates is required:
American College of Radiology (ACR)
Inter-societal Accreditation Commission (IAC)
The Joint Commission (JCAHO)
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites.
Includes all Home Durable Medical Equipment which includes equipment only and cardiac event monitoring only.
Please include the following documents with your application:
A copy of the North Carolina Division of Health Service Regulation or North Carolina Board of Pharmacy Permit-Devise Dispensing Permit, Board of Pharmacy Permit-Devise and Medical Equipment
One of the following documents is needed:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification/Accreditation International (BOC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Home Health Agencies must be accredited. One of the following accreditation certificates or letter attesting to all covered sites is required for each site:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
All of the following services must be provided in order to meet contracting requirements:
Skilled Nursing Visits
Speech Therapy
Physical Therapy
Home Health Aide
Occupational Therapy
Medical Social Services
A copy of the Division of Health Service Regulation license is required for each site
Medicare verification is needed (if applicable)
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate. General liability insurance face sheet must indicate practice/provider address.
Please include the following documents with your application:
All of the following services must be provided in order to meet contracting requirements:
Pharmacy
Nursing
Supplies
A copy of the Division of Health Service Regulation License and Board of Pharmacy Permit-Infusion Services is required for each site.
Home Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS).
One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
On the application form, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Hospice must be accredited. One of the following accreditation certificates (or letter attesting to all covered sites) is required for each site:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Accreditation Commission for Health Care (ACHC)
A copy of the Division of Health Service Regulation license is required for each site.
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Hospitals must be accredited. One of the following accreditation certificates is required:
Commission on Accreditation of Rehabilitation Facilities (CARF)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
National Integrated Accreditation for Healthcare Organizations (NIAHO)
A copy of the Division of Health Service Regulation license is required for each site (or letter attesting to all covered sites).
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
For cardiac event monitoring services within Blue Medicare HMO and Blue Medicare PPO networks only
Please include the following documents with your application:
A copy of the CLIA Full (Level 3) certification or registration (Clinical Laboratory Improvement Amendments) if applicable
Accreditation by College of American Pathologists (CAP) or COLA, American College of Radiology (ACR), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Medicare certification is required:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites
Please include the following documents with your application:
Substance Abuse Intensive Outpatient Facility (SAIOP):
Please include the following documents with your application:
One of the following accreditation certificates is needed (if applicable):
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Accreditation Association for Ambulatory Health Care (AAAHC)
Council on Accreditation for children and family services (COA)
Community Health Accreditation Program (CHAP)
Continuing Care Accreditation Commission (CCAC)
A copy of a North Carolina Business license
Medicare verification:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
General liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate (or letter attesting to all covered sites).
In the application, if you've answered yes to any under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Division of Health Services Regulation License to provider Opioid Treatment
DEA
SAMSHSA Certification ("provisional" SAMSHSA Certification will not be excepted)
Letter of Certification from SAMSHSA
Medicare Provider Number
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
National Accreditation (CARF, Joint Commission, Council on Accreditation, and National Commission on Correctional Health Care)
General and Professional Liability. It must include current coverage dates, facility name, facility address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence / $3 million aggregate.
Contracting requirements are listed below:
This includes all Orthotics and Prosthetics which will include Breast Prosthetics only.
Please include the following documents with your application:
One of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification/Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (JCAHO)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Partial Hospitalization Facilities must be accredited. One of the following accreditation certificates is required:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Commission on Accreditation of Rehabilitation Facilities (CARF)
A copy of the Division of Health Service Regulation license for Partial Hospitalization Services.
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)
Please include the following documents with your application:
Please include the following documents with your application:
CLIA certificate Full (Level 3)
Accreditation by College of American Pathologists (CAP) or COLA (if applicable)
If not accredited by an accrediting agency (CAP or COLA) needs CMS site survey
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Residential Treatment Facilities must be accredited. One of the following accreditation certificates is required:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Commission on Accreditation of Rehabilitation Facilities (CARF)
A copy of the Division of Health Service Regulation license
Medicare verification is needed (if applicable)
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
If not accredited, please provide a copy of the most recent CMS Review.
If you are qualified and enrolled with the National Supplier Clearinghouse as a Medicare certified DMEPOS supplier one of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification/Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (JCAHO)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Copy of the Division of Health Service Regulation license
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Medicare verification is required for each site (or letter attesting to all covered sites).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
On the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Medicare certification is required (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
One of the following accreditation certificates is needed (if applicable):
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
International Standards Organization (ISO)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
American Academy of Sleep Medicine
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)
Please include the following documents with your application:
Board of Pharmacy Permit-Devise and Medical Equipment Permit is required
Medicare certification is required.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Commercial General Liability Insurance of at least 1 mil/3 mil.
A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) if applicable.
Accreditation by URAC
In lieu of the Accreditation by URAC, we can accept pharmacies that have received federal designation as a Hemophilia Treatment Center
Please include the following documents with your application:
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites.
Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS) – we will accept a site survey conducted within the past 3 years.
Please include the cover letter and follow-up letter (if applicable):
Please include the following documents with your application:
Please include the following documents with your application:
Please include the following documents with your application:
Please include the following documents with your application:
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Non accredited Pharmacies must submit exemption letter from Medicare.
One of the following accreditation certificates is needed if no exemption letter from Medicare:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc's "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification/Accreditation International (BOC)
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Blue Medicare HMO and Blue Medicare PPO networks only.
Please include the following documents with your application:
A copy of a NC license or Certificate of Need (if applicable per state or federal regulatory requirements)
One of the following accreditation certificates is required:
American College of Radiology (ACR)
Inter-societal Accreditation Commission (IAC)
The Joint Commission (JCAHO)
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites.
Includes all Home Durable Medical Equipment which includes equipment only and cardiac event monitoring only.
Please include the following documents with your application:
A copy of the North Carolina Division of Health Service Regulation or North Carolina Board of Pharmacy Permit-Devise Dispensing Permit, Board of Pharmacy Permit-Devise and Medical Equipment
One of the following documents is needed:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification/Accreditation International (BOC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Home Health Agencies must be accredited. One of the following accreditation certificates or letter attesting to all covered sites is required for each site:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
All of the following services must be provided in order to meet contracting requirements:
Skilled Nursing Visits
Speech Therapy
Physical Therapy
Home Health Aide
Occupational Therapy
Medical Social Services
A copy of the Division of Health Service Regulation license is required for each site
Medicare verification is needed (if applicable)
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate. General liability insurance face sheet must indicate practice/provider address.
Please include the following documents with your application:
All of the following services must be provided in order to meet contracting requirements:
Pharmacy
Nursing
Supplies
A copy of the Division of Health Service Regulation License and Board of Pharmacy Permit-Infusion Services is required for each site.
Home Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS).
One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
On the application form, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Hospice must be accredited. One of the following accreditation certificates (or letter attesting to all covered sites) is required for each site:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Accreditation Commission for Health Care (ACHC)
A copy of the Division of Health Service Regulation license is required for each site.
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Hospitals must be accredited. One of the following accreditation certificates is required:
Commission on Accreditation of Rehabilitation Facilities (CARF)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
National Integrated Accreditation for Healthcare Organizations (NIAHO)
A copy of the Division of Health Service Regulation license is required for each site (or letter attesting to all covered sites).
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
For cardiac event monitoring services within Blue Medicare HMO and Blue Medicare PPO networks only
Please include the following documents with your application:
A copy of the CLIA Full (Level 3) certification or registration (Clinical Laboratory Improvement Amendments) if applicable
Accreditation by College of American Pathologists (CAP) or COLA, American College of Radiology (ACR), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Medicare certification is required:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites
Please include the following documents with your application:
Substance Abuse Intensive Outpatient Facility (SAIOP):
Please include the following documents with your application:
One of the following accreditation certificates is needed (if applicable):
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Accreditation Association for Ambulatory Health Care (AAAHC)
Council on Accreditation for children and family services (COA)
Community Health Accreditation Program (CHAP)
Continuing Care Accreditation Commission (CCAC)
A copy of a North Carolina Business license
Medicare verification:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
General liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate (or letter attesting to all covered sites).
In the application, if you've answered yes to any under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Division of Health Services Regulation License to provider Opioid Treatment
DEA
SAMSHSA Certification ("provisional" SAMSHSA Certification will not be excepted)
Letter of Certification from SAMSHSA
Medicare Provider Number
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
National Accreditation (CARF, Joint Commission, Council on Accreditation, and National Commission on Correctional Health Care)
General and Professional Liability. It must include current coverage dates, facility name, facility address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence / $3 million aggregate.
Contracting requirements are listed below:
This includes all Orthotics and Prosthetics which will include Breast Prosthetics only.
Please include the following documents with your application:
One of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification/Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (JCAHO)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Partial Hospitalization Facilities must be accredited. One of the following accreditation certificates is required:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Commission on Accreditation of Rehabilitation Facilities (CARF)
A copy of the Division of Health Service Regulation license for Partial Hospitalization Services.
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)
Please include the following documents with your application:
Please include the following documents with your application:
CLIA certificate Full (Level 3)
Accreditation by College of American Pathologists (CAP) or COLA (if applicable)
If not accredited by an accrediting agency (CAP or COLA) needs CMS site survey
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
Residential Treatment Facilities must be accredited. One of the following accreditation certificates is required:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Commission on Accreditation of Rehabilitation Facilities (CARF)
A copy of the Division of Health Service Regulation license
Medicare verification is needed (if applicable)
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Please include the following documents with your application:
If not accredited, please provide a copy of the most recent CMS Review.
If you are qualified and enrolled with the National Supplier Clearinghouse as a Medicare certified DMEPOS supplier one of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification/Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (JCAHO)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Copy of the Division of Health Service Regulation license
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate.
Medicare verification is required for each site (or letter attesting to all covered sites).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
On the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Medicare certification is required (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
One of the following accreditation certificates is needed (if applicable):
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
International Standards Organization (ISO)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
American Academy of Sleep Medicine
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)
Please include the following documents with your application:
Board of Pharmacy Permit-Devise and Medical Equipment Permit is required
Medicare certification is required.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3-6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Commercial General Liability Insurance of at least 1 mil/3 mil.
A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) if applicable.
Accreditation by URAC
In lieu of the Accreditation by URAC, we can accept pharmacies that have received federal designation as a Hemophilia Treatment Center
Board Certified & Non-Board Certified:
Other:
Optometry and Ophthalmology commercial networks are closed in all counties. Optometrist and ophthalmologist participation for routine vision is managed by Community Eye Care (CEC). Contact CEC for participation inquiries and to initiate credentialing and/or recredentialing by email at providers@cecvision.com and by phone. (CEC 888-254-4290)
Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.
All practitioners applying for credentialing and recredentialing have the following rights:
All initial credentialing files for Physicians
All recredentialed files for Physicians
Effective November 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin utilizing the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal (formerly known as CAQH ProView) universal credentialing application. The upcoming changes to our processes will improve quality and timeliness in onboarding our new providers/practitioners to Blue Cross NC. Providers will be required to do the following:
or
This initial step of integrating automation and streamlining onboarding processes will improve turnaround times for credentialing and enrollment.
We appreciate your cooperation and look forward to partnering with you as we transition to a more automated and digitized workflow. Please see the FAQ which provides further guidance and instructions for utilizing these electronic processes.
Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.
Effective Oct. 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin using Verifide, a credentialing verification organization, to conduct primary source verification. Here’s what this means for you:
If you have questions, contact Provider Services at 800-777-1643, option 6.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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