Blue Cross and Blue Shield of Kansas is committed to providing the highest quality provider network for our members. For this reason, we require all providers to complete a credentialing process before being accepted for participation in a Blue Cross network. Credentialing involves collection and verification of a practitioner applicant's professional qualifications, such as relevant training, licensure, certification, and /or registration to practice in a healthcare field, and academic background, as well as assessment of whether the practitioner meets certain criteria relating to professional competence and conduct.
All practitioners and institutions must undergo a two-part credentialing process. The first part involves an initial full review of the provider's qualifications at the time of application. The second part, recredentialing, occurs every three years and involves a full review of the provider's recredentialing application.
The Blue Cross credentials staff verify that provider applications are accurate and complete and that the appropriate information has been authenticated. The Credentials Committee, comprised of both internal and external physicians, depends on the integrity of the work process when making credentialing decisions.
The Universal Credentialing DataSource, developed by America's leading health plans collaborating through the Council for Affordable Quality Healthcare (CAQH), is now available for provider healthcare information. This leading industry-wide service addresses one of provider's most redundant administrative tasks - the credentialing application process - by alleviating the need for providers to complete and submit multiple forms for credentialing with health plans.
With the CAQH program, practitioners use a standard application and a common database to submit one application, to one source, and update it every 120 days to meet the needs of all of the health plans and hospitals participating in the CAQH effort. Practitioners will designate which health plans and hospitals may obtain the application information directly from the database, eliminating the need to have multiple organizations contacting the practitioner for the same standard information. Practitioners update their information every 120 days to ensure data is maintained in a constant state of readiness.
Learn more about the CAQH Universal Credentialing DataSource at the CAQH Web site.
For questions about the Blue Cross credentialing process, call (785) 291-7084.