Verification Process for Hospital or Facility Based Providers
Note: Under the Consolidated Appropriations Act (CAA), all contracted providers must be listed in the provider directory. If you previously chose not to be listed in Provider Finder, your directory information will be displayed starting in February 2022. Directory information includes name, location and hours, contact information, specialties, languages spoken, credentials, affiliations and whether you are accepting new patients. The address you’ve provided to us will be displayed.
Hospital or facility based are providers who practice exclusively in an inpatient hospital or outpatient freestanding facility including ambulatory surgical centers. Eligible specialties include, but are not limited to Anesthesia, Emergency Medicine, Hospitalist, Neonatology, Pathology and Radiology.
We have outlined the information necessary for Hospital/Facility Based providers to become a BCBSTX contracting provider:
Step 1: Review Requirements
Hospital or Facility Based Providers must have the following:
- Hospital or Ambulatory Surgical Center privileges
- Type 1 NPI #
- Texas State Board of Medical Examiners license (temporary permit is acceptable) or appropriate Texas licensure
- Provider must be physically located in the state of Texas.
- Certificate/AANA# (applicable to CRNA providers only)
- NCCAA certificate (applicable to Anesthesia Assistants providers only)
Step 2: Complete the Provider Onboarding Form
Refer to the Provider Onboarding Process to obtain a provider record ID and indicate your request to participate in the networks. When completing the form or roster:
- Ensure all provider information is included on the on-boarding form and roster. Completing this information up front and accurately, in its entirety, will prevent delays in processing. Examples: Name, date of birth, NPI, social security number, gender, tax ID, etc.
- Individual providers need to provide the name of all Hospital or Ambulatory Surgery Centers that the provider services in the Hospital Admitting Privileges field(s) of the Provider Onboarding Form.
- Group Providers need to include the name of all Hospital and/or Ambulatory Surgery Centers that they service. This must be included in the Hospital Privileges and/or Ambulatory Surgery Centers Privileges columns of the Provider Onboarding Roster.
Additional providers being added to previously contracted groups will be processed from the roster information.
For new groups and individual providers, upon receipt of the fully completed Provider Onboarding Form , and roster (for group providers), you will be sent the contracts for which you are eligible to participate along with instructions on how to complete and submit your signed contract(s). Providers will be processed upon receipt of the signed contracts.
If you have completed a Provider Onboarding Form, you can check the status by referring to the Case and Credentialing Status Checkers.
Note: A BCBSTX Provider Record ID does not automatically activate the networks. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.