Blue Shield How to Find a Provider Instructional Sheet

Note: Use the Demographic Change Form, if you already have a BCBSTX Provider Record IDand only need to update your demographics (i.e., address, phone, specialty).

Before you can join the BCBSTX Provider Networks or send claims electronically as an out-of-network provider, you will need to be assigned a BCBSTX Provider Record ID.

Provider Record ID Set Up

Termination of Unused Provider Record ID:Please Note: BCBSTX may automatically cancel a Provider Record ID that does not have any claim dates of service within a 12-month time period. A new request will need to be submitted to reinstate it.

Physicians, Professional Providers and Hospital/Facility Based Providers

• Complete theProvider Onboarding Form

When filling out the Provider Onboarding form, use Google Chrome for best results.

• Providers who want to be in-network will have additional fields to complete on the form.

• Providers can select the question mark icon where available if they need assistance with those fields.

Professional Providers

• If you do not already have a Provider Record ID established with BCBSTX that matches your billing information (Rendering NPI, Billing NPI and TIN), you will need to complete the Provider Onboarding Form.
• A complete, signed and dated W9 and a copy of each provider's license is required with all new group and solo practitioner Provider Onboarding Form submissions.

Group Providers

• Complete the Provider Onboarding Form using the group information. Complete the required Provider Roster for providers that need to be affiliated with your group Tax ID and Billing NPI. (For existing groups – please only send new providers and not a full roster)
• You must download the required Provider Roster and submit in the provided format.
• One Tax ID per onboarding request.

NOTE: Submitting incorrect rosters or missing rosters may result in your application being returned

Hospital/Facility Based providers

• New individual providers will need to provide the name of each Hospital or Ambulatory Surgery Center that the provider services on the comments section of the Provider Onboarding Form.
• When adding providers to an existing contracted group/clinic, you must use the Provider Roster template entering the Hospital or Ambulatory Surgery Center in the comments section.

Ancillary Providers

• Complete the Ancillary Provider Record Request Form and fax to the number on the form along with the supporting documents indicated on the form.
• Once you are notified your Provider Record ID has been created, refer to theCredentialing and Contracting Process for Ancillary Providers.

Hospital Providers

• Submit your information to the appropriate Network Management Office location.

ParPlan

When completing the Provider Onboarding form, physicians, professional providers, hospital/facility-based providers can sign and submit a ParPlan contract. Refer to the ParPlan page for more information.The ParPlan contract must be signed by the:

• Authorized signatory for group providers
• Provider for solo practitioners.

Return the signed ParPlan contract with your Provider Onboarding Form or submit later by email to Standard Contracting Team or to your local Network Management Office.

Note: By signing a ParPlan contract, the provider is only active in ParPlan, not any other networks. Providers would need to be contracted and credentialed to be active in those networks.

Get Connected

Enroll in our electronic commerce options to help ensure timeliness, accuracy and security of claims-related information. The fastest way to conduct business with BCBSTX throughout the entire claims process is via:

• Electronic Data Interchange (EDI)
• Electronic Funds Transfer (EFT)
• Electronic Remittance Advice (ERA)
• Electronic Payment Summary (EPS)

Check your status

If you have completed a Provider Onboarding Form, you can check the status using the Case Status Checker.

Reminders

• Obtaining a BCBSTX Provider Record ID does not automatically activate the networks. When you indicate on the Provider Onboarding Form that you want to be a participating provider you will be sent the contracts along with instructions on how to complete and submit your contract(s). Claims will be processed out-of-network, until the provider is contracted, approved and activated in the network.
• The previous paper forms for obtaining a Provider Record ID will no longer be accepted . A complete, signed and dated W9 and a copy of each provider's license is required with your Provider Onboarding application submission.

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Source: https://www.bcbstx.com/provider/network/network/provider-onboarding-process

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