How to Become a Blue Shield of California Provider

Getting credentialed on medical insurance plans is never easy. Blue Shield of California is one of the easier ones and here is the step-by-step guide.

If you want guidance on basic insurance provider requirements (e.g., applying for CAQH) or if you’re looking to apply to additional plans, check out our in-depth Optometrist Credentialing Guide.

Guide to joining Blue Shield of California

Joining Blue Shield of California requires you to fill out the AGREEMENT -or- the AGREEMENT and the CREDENTIALING APPLICATION. When I called the company, they told me that optometrists need to fill out the AGREEMENT and CREDENTIALING if they are contracted with TRICARE/TRIWEST insurance plan. If they are not, then you just need to fill out the AGREEMENT. Once approved, you to become a part of Blue Shield of California’s Provider Network.

optometry blue shield of california

Agreement

  1. Agreement – Download the Blue Shield of California Agreement – Click Here
  2. Website – Although not necessary, here is the BS California Provider Website
  3. Phone Contact – If you need to, the contact number for help with the application is (800) 258-3091
  4. Pages To Complete – page 2, page 3, page 24, page 25, page 26, page 27 – Note: the other pages are the details of the contract you are signing. This is a legally binding contract, so I suggest reading it to understand what you are agreeing to. If you are unsure, seek legal council or call Blue Shield.
  5. Send it in – Send in all documentation  by one of the following methods:

    By Fax: (916) 350-8860
    By Email:  PSCEDHB_1 (at) blueshieldca.com
    By USPS:

    Blue Shield of California
    Attn: Provider Services
    PO Box 629017
    El Dorado Hills, CA 95762-9010

  6. Confirmation – Participating Providers will be assigned an effective date based upon completion of Blue Shield Credentialing if applicable, and the receipt and completion of all required documentation. A copy of the executed Agreement (if submitted), including the assigned effective date, will be returned to you when processing is completed.
In my situation, the practice was already part of Blue Shield of California but, I was not. So when I filled out the Provider Identification Number form, I checked (add to group provider No. _________). This allowed me to be added to the group. Keep in mind, in most cases, you will use the business’s tax ID when doing this type of stuff. In my situation, I wanted insurance reimbursement checks to go to the practice, not me personally. So I called Blue Shield of California and got the Provider No. for my practice instead of creating a personal one for myself.

Credentialing

  1. Call Credentialing and request a “credentialing application” –  (888) 398-2250
  2. Fill out the credentialing application.
  3. Send in your application

Send your completed application and all required documentation via U.S. Mail, fax or e-mail to:

U.S. Mail:
Blue Shield of California
Credentialing Department SF-21
P.O. Box 7168
San Francisco, CA 94120-9837

Fax: (888) 221-1460

E-mail: BSC_Credentialing@blueshieldca.com

Credentialing Department at (888) 398-2250
Provider Services Liaison Unit at (800) 258-3091

AGREEMENT—Items you must send to Blue Shield of California

  1. Provider Identification Number Application Form – Completed PIN Application signed by the provider of service, owner/director, or corporate officer.
  2. Include a copy of current license issued by the California State Board of Examiners or National Board Certification for professionals not licensed by the State of California. 
  3. Employer Identification Number – If earnings are to be reported under an Employer Identification Number (EIN), include a copy of pre-printed IRS documentation showing EIN/Name combination recognized by the IRS. (SS-4 form, 147-C form, or copy of the Federal Tax Deposit Coupon, are examples of acceptable pre-printed documents.)
  4. National Provider Identifier- If the individual provider or entity has a NPI number, include a copy of the E-mail notification from the Enumerator or NPPES screen print or CMS / Enumerator notification letter.
  5. Group Roster- If a group/business, include a group roster listing the individual provider name(s), license number(s), and NPI number(s).
  6. Articles of Incorporation – If incorporated, include a copy of the current Articles of Incorporation from the Secretary of State.
  7. Fictitious Name Statement or Permit- If using a fictitious name, provide a copy of the current Fictitious Business Name Statement from the provider’s county , or, Optometry businesses using a fictitious name include a copy of the Fictitious Name Permit from the Optometry Board of California.
  8. Allied and Ancillary Provider Agreement – Completed Allied and Ancillary Provider Agreement signed by the owner, director, or corporate officer. Some provider types must be credentialed by Blue Shield prior to execution of the Agreement. If entity is a group/business; provide group/business name on page 1 and Exhibit A. Please return ALL pages of the agreement for processing. Altered Agreements will be voided and returned.

CREDENTIALING—Items you must send to Blue Shield of California

  • Credentialing application – Signed and dated.
  • Information about any malpractice actions that may have been taken against you, including settlement amounts and/or explanation of any dismissed or pending claims with pertinent dates included (see application page 4 of 7).
  • Hospital privilege including any additional information as applicable (see application page 5 of 7).
  • Curriculum vitae – Please include an explanation of any work history gaps greater than six months
  • Current Malpractice Liability Insurance Certificate – Current Blue Shield of California requirements are $1 million per occurrence and $3 million aggregate for all contracted practitioners except Allied Health Providers who require $1/$1 million.
  • Copy of your Drug Enforcement Administration (DEA) certification, if applicable.
  • Copy of your current license.

What to expect when you are done

After the your credentialing application has been processed you will receive an approval letter stating that you successfully passed review by our Credentialing Committee for continued participation with the BSC provider network.

This should be give you a good head start but, undoubtedly things will come up. If you comment below, our team and our fans will reply to your comments with some answers!

 

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About Matt Geller

Matthew Geller
Dr. Matt Geller is a technology entrepreneur with a track record of developing successful online platforms to solve problems in the healthcare space. Matt is an optometrist in San Diego and is the founder of OptometryStudents.com, NewGradOptometry.com and the co-founder of CovalentCareers.com!

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