Regence BlueShield contracts with physicians, other
health care professionals and facilities to form provider
networks essential for delivery of health-care services
to our members. All physicians and other health care
professionals must be credentialed before they can
participate in Regence provider
networks.
- Review the list of provider
types to determine
whether the network panel is opened or closed
- For open panels please follow the application process
outlined below
- For closed panels complete the secure
form to request a provider agreement
should the network
in your area open. We will contact you
at that time with information about our
contracting and credentialing process.
Learn
more about our Credentialing
(PDF) process.
| Hospital-Based
Practitioner Information Form |
Hospital-Based
Practitioner Information Form (PDF) |
Use this form when a provider is being added
to a hospital-based facility. Regence
BlueShield defines Hospital Based Practitioners
as, “Practitioners
who practice exclusively within a hospital setting,
meets our credentialing and contracting criteria
and provides care for Regence
BlueShield members
only as a result of members being directed to the
hospital or other inpatient setting." |
Indian or Tribal Health Clinic credentialing requirements
Effective January 1, 2009 Regence will require that all Indian/Tribal Health Clinic providers complete the credentialing process prior to contracting. Indian/Tribal Health Clinic providers will also be required to go complete the recredentialing process at a minimum of every three years.
Change in Participating Effective Date Policy
Effective April 1, 2008, all physicians and other health care professionals must be credentialed before they can participate in a Regence provider network.
Beginning April 1, 2008, the following policy will apply to all participating providers:
- New provider agreements will have an effective
date of the first day of the month in which the provider
was credentialed (e.g., if credentialing was approved
on June 14, the agreement will be effective on June
1).
- If Regence does not receive a signed agreement in the same month as credentialing is completed, the agreement effective date will be the first of the month in which credentialing is approved or the signed agreement is received, whichever is later.
- A new provider joining a group or clinic agreement will have an effective date of the first day of the month in which he or she was credentialed (e.g., if credentialing was approved on June 14, the effective date of participation will be June 1).
- If a provider already participating with Regence adds an additional network, the effective date of the new network will be the first day of the month the signed agreement is received.
- Regence will no longer establish retroactive agreement effective dates.
- Claims submitted to Regence for dates of service prior to the provider’s effective date will be processed as out-of-network.
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