Provider Network Solutions Operations

Provider Network Solutions Operations is a centralized, dedicated team that supports the integrity and accuracy of the BCBSKS provider network. This team is responsible for:

• Network enrollment and credentialing
• Provider record maintenance
• Contract eligibility
• Provider directory data management
• Provider network regulatory compliance

Through these functions, Provider Network Solutions Operations helps ensure our network meets business needs and regulatory standards while supporting timely and accurate provider participation.

Provider Network Applications and Forms

Provider network applications and forms are updated as business and regulatory requirements change. Outdated forms can result in processing delays or the need to resubmit information. To avoid delays, use the most current forms available on the BCBSKS website under the appropriate line of business:

• Facility Providers:
  bcbsks.com/providers/institutional/forms
• Professional Providers:
  bcbsks.com/providers/professional/forms

Credentialing

Credentialing occurs at initial enrollment and every 36 months through recredentialing. Recredentialing approval must be completed before the credentialing anniversary date expires.

Credentialing ensures that providers meet established standards and are approved to participate in the BCBSKS network. The Credentialing Program is regularly reviewed to maintain compliance with accreditation requirements and state and federal regulations.

Find credentialing criteria on our website:

• Facility Providers:
  bcbsks.com/providers/institutional/resources
• Professional Providers:
  bcbsks.com/providers/professional/publications

BCBSKS is not responsible for network terminations for missed deadlines due to outdated or unattended contact information. Accurate contact information allows timely communication and processing.

All credentialing requirements must be current at initial application and throughout the recredentialing cycle. Applications with expired or missing verification elements will be rejected and may result in network termination if recredentialing deadlines are not met.

To prevent disruptions to network participation:

• Respond promptly to BCBSKS credentialing outreach
• Keep contact information current in your BlueAccess profile
• Update your contact information as soon as changes occur