Credentialing Program
Participating providers are expected to cooperate with quality-of-care policies and procedures. An integral component of quality of care is the credentialing of participating providers. This process consists of two parts: credentialing and recredentialing.
Credentialing Process
Credentialing consists of an initial full review of a provider’s credentials at the time of application to our networks.
1. If a provider applies for participation in any of our networks, credentialing is required before being approved for participation. A Louisiana Standardized Credentialing Application (LSCA) and provider agreement are forwarded to the provider upon receipt of the request for participation in our networks. This form can be found on our website at www.bcbsla.com/providers >Forms for Providers or Credentialing.
2. The form and agreement are completed by the provider and submitted to Blue Cross for approval.
3. Upon receipt of the completed LSCA, credentialing staff verify the provider’s credentials
including, but not limited to, state license, professional malpractice liability insurance, State CDS Certificate, etc., according to the Plan’s policies and procedures and Utilization Review Accreditation Committee (URAC) standards.
4. Blue Cross staff and the Credentialing Committee, review the provider’s credentials to ascertain compliance with the following credentials criteria. All participating providers must maintain this criteria on an ongoing basis:
• Unrestricted license to practice medicine in Louisiana as required by state law
• Agreement to participate in the Blue Cross networks
• Professional liability insurance that meets required amounts
• Malpractice claims history that is not suggestive of a significant quality of care problem
• Appropriate coverage/access provided when unavailable on holidays, nights, weekends and other off hours
• Absence of patterns of behavior to suggest quality of care concerns
• Utilization review pattern consistent with peers and congruent with needs of managed care
• No sanctions by either Medicaid or Medicare
• No disciplinary actions
• No convictions of a felony or instances where a provider committed acts of moral turpitude
• No current drug or alcohol abuse
5. Based upon compliance with the criteria, Blue Cross staff will recommend to the Credentialing Committee that a provider be approved or denied participation in our networks.
6. The Credentialing Committee, comprised of network practitioners, will make a final recommendation of approval or denial of a provider’s application.
Participating providers are expected to cooperate with quality-of-care policies and procedures. An integral component of quality of care is the credentialing of participating providers. This process consists of two parts: credentialing and recredentialing.
Credentialing Process
Credentialing consists of an initial full review of a provider’s credentials at the time of application to our networks.
1. If a provider applies for participation in any of our networks, credentialing is required before being approved for participation. A Louisiana Standardized Credentialing Application (LSCA) and provider agreement are forwarded to the provider upon receipt of the request for participation in our networks. This form can be found on our website at www.bcbsla.com/providers >Forms for Providers or Credentialing.
2. The form and agreement are completed by the provider and submitted to Blue Cross for approval.
3. Upon receipt of the completed LSCA, credentialing staff verify the provider’s credentials
including, but not limited to, state license, professional malpractice liability insurance, State CDS Certificate, etc., according to the Plan’s policies and procedures and Utilization Review Accreditation Committee (URAC) standards.
4. Blue Cross staff and the Credentialing Committee, review the provider’s credentials to ascertain compliance with the following credentials criteria. All participating providers must maintain this criteria on an ongoing basis:
• Unrestricted license to practice medicine in Louisiana as required by state law
• Agreement to participate in the Blue Cross networks
• Professional liability insurance that meets required amounts
• Malpractice claims history that is not suggestive of a significant quality of care problem
• Appropriate coverage/access provided when unavailable on holidays, nights, weekends and other off hours
• Absence of patterns of behavior to suggest quality of care concerns
• Utilization review pattern consistent with peers and congruent with needs of managed care
• No sanctions by either Medicaid or Medicare
• No disciplinary actions
• No convictions of a felony or instances where a provider committed acts of moral turpitude
• No current drug or alcohol abuse
5. Based upon compliance with the criteria, Blue Cross staff will recommend to the Credentialing Committee that a provider be approved or denied participation in our networks.
6. The Credentialing Committee, comprised of network practitioners, will make a final recommendation of approval or denial of a provider’s application.
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