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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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Medical Professional Providers and Ancillary Providers

CAQH Streamlines Credentialing Process 
Blue Cross and Blue Shield of Georgia is pleased to be part of the Credentialing Data Initiative developed by the Council for Affordable Quality Healthcare (CAQH). The CAQH’s sophisticated online database allows physicians and other health care providers to complete one application and enter credentialing application information into one easy-to-use database, which helps to eliminate the paperwork and hassle that many providers face during the credentialing process.   
With the physician’s authorization, the information will be shared with participating health plans and other participating organizations that require it. The basic information must be provided only once, and updates are easy. Providers are contacted regularly to verify that the information in the database is current. The CAQH application is consistent with the mandated uniform application and complies with state regulations. There is no charge for physicians to use the tool.  
Providers who require credentialing by BCBSGa must apply for a CAQH ID before applying for participation in our BCBSGa networks because a CAQH ID is required on our New Provider Application Form. If you already have a CAQH ID number and have completed a CAQH application, please proceed to section below for completing the BCBSGa application. The CAQH ID Number Request Form should be completed only by those credentialed provider types to apply for a CAQH ID. (Note: If your provider type is not listed, you do NOT need to apply for a CAQH ID – proceed directly to the New Provider Application Form.)  
Completing the BCBSGa application  
Credentialed providers: Once you’ve received your CAQH ID number and completed the CAQH application, complete the first section of the application form titled ‘Credentialed Providers’. Please verify that you have granted BCBSGa permission to access your CAQH application. If you have not previously granted such permission, please contact CAQH through its website, or call 888-599-1771. 
Ancillary providers: Please complete the Ancillary section if you are a lab, ground or air ambulance, hearing aid distributor, durable medical equipment, home IV, immunization clinic, orthotic and prosthetic, cardiac event monitoring, or medical specialty pharmacy. Before completing the application form, click here for important information about closed networks.  
All other providers and professionals: Please complete the Non-Credentialed Provider section.  
Steps in the Provider Application Process 
As a potential BCBSGa network provider, you must meet the following four requirements and follow the credentialing instructions listed below:  
Liability insurance with a coverage minimum of $1,000,000 per claim and $3,000,000 aggregate
Hospital visiting privileges with one of our participating hospitals
Unrestricted state license
Board certification or eligibility
Apply for Network Participation
To begin the application process with us, please complete the New Provider Application Form and submit.  
A copy of the IRS Form W-9 will be requested with the return of the Agreement Packet after this application is reviewed.  
Please note: Credentialing for a provider may take up to 90 days from receipt of a completed application. To check the status of your application, please contact your local BCBSGa network consultant. 
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