Network Participation

Blue Cross and Blue Shield of Oklahoma (BCBSOK) contracts with physicians and other professional providers to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services to our members.

If you are interested in applying to join our provider networks, follow the steps outlined below. We look forward to working with you!

NOTE: Hospitals, Ambulatory Surgery Centers and Ancillary Providers should send an email to OK Network Management to request information regarding how to join our networks.

SIX EASY STEPS TO JOIN!

• Step 1 — Complete Provider Onboarding Form.

  To apply to join our networks, you will need to complete the Provider Onboarding Form .
  (For the best user experience, use Chrome browser.)

  Solo Provider Onboarding

  Complete the Solo Provider Onboarding Form if:

  • You are a new solo provider that is practicing under your own SSN or EIN without a Level 2-Organzational NPI. Review the Machine-Readable File rule when determining if you are going to use your SSN or if you need to register for a new Taxpayer Identification Number.
     

  Group/Clinic Provider Onboarding

  Complete the Group/Clinic Provider Onboarding Form if:

  • You are a new provider being added to an existing group with a Level 2-Organization NPI
  • You are a new group/provider with a Level 2-Organization NPI
     

  Each provider interested in becoming contracted with BCBSOK should attach the following when completing the Provider Onboarding Form, as applicable. Incomplete submissions will be rejected.

  Required for all Providers:

  • Current Oklahoma State Healthcare License - Provider Must be Located in the State of Oklahoma, Performing Services in the State of Oklahoma and have an Oklahoma Service Location listed on their Board License (if applicable).
  • Malpractice Liability Insurance
  • Provider Disclosure of Ownership and Control Interest Form 
  • Valid W-9
     

  As applicable by provider type:

  • Behavioral Health Professional Areas of Expertise 
  • Call Coverage Designation & Credentialing Contact Information 
  • Clinical Laboratory Improvement Amendments (CLIA)
  • Federal DEA license and State Controlled Substance registration
  • Hospital Coverage Letter 
  • Physician (MD/DO), Oral Surgeon (DDS/DMD) or Podiatrist (DPM) Prescribing Authority Supplemental Questionnaire 
  • Physician Assistants Supervising/ Collaborating/Monitoring Physician Protocols/Duties/Scope of Practice Supplemental Questionnaire 
  • Advanced Practice Nurses Collaborating/Supervising/Monitoring Physician Protocols/Duties/Scope of Practice Supplemental Questionnaire 
  • Advanced Practice Nurse Prescribing Authority Supplemental Questionnaire 
  • Physician Assistant Prescribing Authority Supplemental Questionnaire 
     

• Step 2 — Initial review process

  Requests to join the BCBSOK network are reviewed by a multi-disciplinary team. We make every effort to keep health insurance affordable and accessible to all Oklahomans. As part of that commitment, we actively seek relationships that foster a partnership between our organization and providers and address network needs.

  After review, we will notify you of whether you may proceed to Step 3.

• Step 3 — Submit a signed contract
  
  If you successfully complete Steps 1-2, you may receive a contract from our Standard Contracting Team (SCT) for participation in one or more BCBSOK networks. Contracts will come from OK_StandardContracting@bcbsok.com. Sign and return the contract to OK_StandardContracting@bcbsok.com to move to step 4.

• Step 4 — Become credentialed

All providers who participate in our networks are required to complete the credentialing process. Our credentialing requirements follow applicable law and accreditation standards.

For more information review the APRN (CNP and CNS) Credentialing Process.

If you are credentialed through this process, you may proceed to Step 5. If you are not approved, we will notify you of the outcome and any applicable appeal rights.

• Step 5 — Contract(s) are accepted and processed

  Once the signed contract(s) are processed you will receive a welcome letter that specifies your network effective date(s).

• Step 6 — Get connected.

Once you are part of our networks, we strongly encourage you to use all available electronic options for electronic data interchange (EDI) transactions to help ensure timeliness, accuracy and security of claims-related information. Please visit the Electronic Commerce section of our website under "Claims and Eligibility".

NOTE: Completing a Provider Onboarding Form or any other process described above in Steps 1-2 does NOT mean that you are a participating provider or guarantee that a contract will be offered.

Case Status Checker

If you have completed one of the following and would like to check the status, enter the case number you received in your confirmation email in our Case Status Checker .

• Provider Onboarding Form
• Demographic Update Form
• General Email inquiries

Credentialing Status Checker

After you submit the Provider Onboarding Form to get credentialed, check the status of your credentialing process by entering your NPI or license number in our Credentialing Status Checker .

Credentialing is the process by which Blue Cross and Blue Shield of Oklahoma (BCBSOK) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards.

Effective May 17, 2010, the Council for Affordable Quality Healthcare, Inc. (CAQH) will collect the data required for our credentialing and recredentialing process. CAQH uses a Universal Provider Datasource® (UPD) form to electronically collect the data. This online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database. Providers may utilize the UPD at no cost.

NEW: CAQH Tool Verifies Credentialing Information

We are working with Verisys to verify data after you enter it into ProView. Verisys may contact you on behalf of BCBSOK and request that you:

• Reattest to your data’s accuracy, or
• Complete your credentialing application by entering or attaching missing information in CAQH ProView

Please respond as soon as possible to help complete the credentialing process. 

The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH is solely responsible for its products and services, including the Universal Provider Datasource.

Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following:

• Right to review information submitted on or with their credentialing and recredentialing application;
• Right to correct erroneous information;
• Right to be informed of the status of their credentialing or recredentialing application, upon request.

Under the Consolidated Appropriations Act of 2021, all contracted providers must be listed in the provider directory. If you’re a contracted provider, you must become credentialed with BCBSOK to be listed in Provider Finder®. Note: Tribal providers are excluded.

Applicants should direct all requests to their Network Management Representative. The Enterprise Credentialing Department will notify the Applicant in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be given sufficient time to correct erroneous information and resubmit to the Enterprise Credentialing Department. It will be the Applicant's responsibility to work directly with the reporting entity(ies) to correct the erroneous information.

Verify separately for the provider directory: Entering and attesting to data in CAQH doesn’t verify the information needed for the federal Consolidated Appropriations Act (CAA). The CAA requires that certain directory information be verified every 90 days, even if your data hasn’t changed since you last verified it. We recommend that professional providers use Availity^® Essentials Provider Data Management feature to quickly verify your directory information with us and other insurers every 90 days. Facilities must use the Demographic Change Form to verify their data. Learn more on our Verify and Update Your Information page.

All BCBSOK providers must have a CAQH Provider ID to register and begin the credentialing process.

First time CAQH users

• If you are not registered with CAQH and are a first-time user, when you apply for network participation, we will add your name to our roster with CAQH. CAQH will mail you access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate online access to the UPD.
• When you receive your CAQH Provider ID, go to the CAQH website to register. After validating key information, you will be able to create your own user name and unique password to begin using the UPD database.
• Once registration is completed, you may use your user name and password to log in at any time.
   

Existing CAQH users

• If you are already registered with CAQH through another health plan, log in to the UPD and add BCBSOK as one of the health plans that can access your information.
• Go to https://upd.caqh.org/ (type address into browser), and enter your username and password.
• Click the "Authorize" tab located under the CAQH logo.
• Scroll down, locate BCBSOK, and check the box beside BCBSOK. You may also select "global authorization." If you have chosen "global authorization," then BCBSOK will already have access to your data.
• Click “Save” to submit your changes.

The UPD standardized application is an online form that meets the needs of all participating health care organizations. When completing the application, you will indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the UPD service is maintained by CAQH in a secure, state-of-the-art data center.

When you are ready to begin entering your data, log in to the UPD with your user name and password.

The following materials are helpful to reference while applying:

• Previously completed credentialing application
• List of previous and current practice locations
• Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc.)
• State medical license(s)
• Curriculum Vitae
• Drug Enforcement Administration Certificate
• Controlled and Dangerous Substances Certificate
• IRS Form W-9(s)
• Malpractice insurance face sheet
• Summary of any pending or settled malpractice cases

After completing the application, you will also be asked to:

1. Authorize access to your information – List the organizations that you would like to receive your information. You may select "BCBSOK" or "global authorization."
2. Verify your data entry – Review a summary of your data for completeness and to make any changes as necessary.
3. Submit supporting documents – To complete your application, fax the supporting documentation to CAQH at
   (866) 293-0414.

If you have any questions on accessing the UPD database, you may contact the CAQH Help Desk at (888) 599-1771 for assistance.

BCBSOK may need to supplement, clarify, or confirm certain responses on your application with you. Therefore, you may be required to provide us with supplemental documentation in some situations, in addition to the information you submit through the UPD.  You will receive notification if any additional information is needed by BCBSOK.

Visit the CAQH website for more information about the UPD and the application process. You may also contact your BCBSOK provider representative with any questions regarding this new procedure.

Credentialing Criteria

1. Must have a current and valid Oklahoma license that must be free from any reprimands, restrictions, sanctions, probation, or disciplinary actions (voluntary or mandated) during the past five (5) years. Exceptions may be made by the Credentialing Committee.

2. If previously licensed in another state, that state license must be free from any administrative fines, reprimands, restrictions, sanctions, probation, or disciplinary actions (voluntary or mandated) during the past five (5) years. Exceptions may be made by the Credentialing Committee.

3. Malpractice insurance minimum: 

• Individual Requirement: $500,000 per occurrence, $1,000,000 per aggregate, or the limits of where admitting privileges are held, whichever is greater.

• Greater Coverage Requirement: $1,000,000 per occurrence; $3,000,000 per aggregate

• Self-Insured Group Coverage: $1,000,000 for Physicians
   

4. Malpractice history regarding claims, settlements, and judgments must be submitted with the application.

5. Must be in good standing with Medicare and Medicaid and be free from any state/federal sanctions.

6. Must be free from any history of fraud or felony convictions.

7. Must have a current, valid, and unrestricted DEA certificate. The DEA certificate must list an Oklahoma Practice Location. A current, legible, unaltered copy of the certificate should be submitted with the application. Exceptions may be made for selected specialists who do not require a DEA for their scope of practice. Note: May not be applicable to Health Care Professionals.

8. Must be currently free from substance abuse/illegal drug use and any reprimands, restrictions, sanctions, probation, or disciplinary action (voluntary or mandated) for such abuse. Recommendations from the Oklahoma State Medical Association Health Professionals Program will be considered.

9. Must submit history of all disciplinary action taken by any board, facility, clinic, or professional governing body.

The following items apply to Primary Care or Specialist Physicians only.

10. The physician must be a member in good standing of the admitting medical staff of at least one network hospital. All hospital privileges must be free from any history of restrictions or suspensions, either voluntarily or involuntarily. If the physician does not have privileges at a participating network hospital, a letter must be submitted by a participating physician in the same specialty with admitting privileges who agrees to admit and treat the applicant’s patients.

• Hospital staff privileges are not required for Specialists practicing in the following areas: Allergy, Anesthesiology, Dermatology, Emergency Medicine/Urgent Care, Nuclear Medicine, Occupational Medicine, Ophthalmology, Pain Management, Pathology, Podiatry, Radiology, and Radiation Oncology.

11. The physician is required to provide call coverage 24 hours per day, 7 days per week. The physician’s call coverage arrangements must include a designated “covering physician” who participates in (or is applying for participation in) the same network and specialty as the applicant.

• Allergy, Dermatology, Emergency Medicine/Urgent Care, Hospitalists, Occupational Medicine, Pathologists and Blue Plan65 Select applicants do not have to meet this requirement.

12. The physician must be either (1) board certified in primary specialty by the American Board of Medical Specialties, American Osteopathic Association, American Board of Podiatric Surgery or American Board of Podiatric Orthopedics and Primary Podiatric Medicine or (2) must have successfully completed an ACGME, AOA, APMA or ABPOPPM accredited post graduate training program in primary specialty. Exceptions may be made in underserved, rural communities.

• Emergency Medicine/Urgent Care physicians may be board certified or completed a residency in a primary care specialty.

Forms Required by BCBSOK for Credentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete the form(s) and forward to BCBSTX:

• Hospital Coverage Letter  – required to be submitted to BCBSOK for those providers who do not have admitting privileges at a participating network hospital.
• PA Supplemental Questionnaire – Prescribing Authority  – required for a PA who plans to prescribe controlled substances and holds a current DEA and State Controlled Substance Certificate.
• Supervising Physician and Protocols & Duties Supplemental Questionnaire  – required for Physician Assistant to provide the name of their Supervising Physician and attest to having protocol/duties.

Keeping your information current is your responsibility. You will be sent automatic reminders to review and attest to the accuracy of your data. Use the CAQH database to report any changes to your practice, in accordance with the time frames outlined in the State of Oklahoma.

You must enter your changes into the UPD database for us to access. Only health plans that participate in the UPD and that have been authorized by you to access your information will receive any changes.

Medicare Advantage Access Standards for Primary Care

Routine and Preventative Care:

• Appointment available within 30 business days

Services that are not urgent or emergency, but requires medical attention

• Appointment available within 7 business days

Urgent or Emergency Services (acute symptoms of sufficient severity):

• Immediately care

Emergency medical conditions: CMS defines emergency medical condition as:

A medical condition, mental or physical, manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a reasonable and prudent layperson could expect the absence of immediate medical attention to result in:

• Serious jeopardy to the health of the individual or, in case of a pregnant woman, the health of the women or her unborn child;
  
• Serious impairment to bodily function; or
• Serious dysfunction of any bodily organ or part.

Medicare Advantage Access Standards for Behavioral Health and Substance Abuse

Urgent or Emergency Services (acute symptoms of sufficient severity):

• Immediate care

Services that are not urgent or emergency, but requires medical attention

• Appointment available within 7 business days

Routine and Preventative Care:

• Appointment available within 30 business days

Emergency medical conditions: CMS defines emergency medical condition as:

A medical condition, mental or physical, manifesting itself by acute symptoms of sufficient severity, including severe pain, such that a reasonable and prudent layperson could expect the absence of immediate medical attention to result in:

• Serious jeopardy to the health of the individual or, in case of a pregnant woman, the health of the women or her unborn child;
• Serious impairment to bodily function; or
• Serious dysfunction of any bodily organ or part.

Medicare Advantage Access Standards for Hours of Operation

• Hours of operation of providers are convenient to the population served and do not discriminate against Medicare member
• Services are available to members 24 hours a day, seven days per week, when medically necessary

CAQH requires you to review and attest to your data once every four months. At the time you are scheduled for recredentialing, BCBSOK will send your name to CAQH to determine if you have already completed the UPD credentialing process. If so, we will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you. The process of recredentialing is identical to that for credentialing and is consistent with accreditation guidelines and State of Oklahoma requirements.

If your application is not available to BCBSOK, you will be added to our roster. CAQH will send you a registration letter and a CAQH Provider ID so that you can complete the UPD credentialing process. This will help you continue to conform to the requirements of your BCBSOK contract.

NEW: CAQH Tool Verifies Credentialing Information

We are working with Verisys to verify data after you enter it into ProView. Verisys may contact you on behalf of BCBSOK and request that you:

·       Reattest to your data’s accuracy, or

·       Complete your credentialing application by entering or attaching missing information in CAQH ProView

Please respond as soon as possible to help complete the recredentialing process. 

Upon completion of the recredentialing process, providers are considered approved unless notified otherwise. Notification of the recredentialing decision, other than approval, will be mailed within ten (10) business days of the decision.

Office hours must reflect each practice location, facility and individual provider. All provider applications request office hours be submitted. Our members rely on the accuracy of the provider information in our Provider Finder^®. If the office hours are not submitted on the application, office hours will be listed as 8 a.m. to 5 p.m. If this is an inaccurate representation of your hours, please update the correct information in the Demographic Change Form.