Provider Enrollment Form

Introduction

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Completion and acceptance of this enrollment form by BlueCross BlueShield of Tennessee is not a guarantee of network participation. BlueCross BlueShield of Tennessee policies and procedures will govern appeals related to this Provider Enrollment Form. This enrollment form must be completed in its entirety to begin the contracting and credentialing process.

CAQH Provider ID

BlueCross BlueShield of Tennessee partners with CAQH Solutions, which offers providers a single point of entry for information. By applying for Network Participation via this form you agree to be included in our roster with CAQH.

Existing CAQH Providers

If you are already registered and have a CAQH Provider ID, please verify that:

  • your information is current and matches the information submitted on this enrollment form.
  • you have completed a CAQH ProView online application; and
  • all supporting documents are current and attached to your CAQH profile.
  • you have "authorized" BlueCross BlueShield of Tennessee to access your credentialing information. (If you selected "global authorization," then BlueCross already has access to your data.)

If you have not authorized BlueCross to access your credentialing information, you can complete your authorization by using the four easy steps below:

To allow BlueCross BlueShield of Tennessee access to your data:

  1. Go to https://proview.caqh.org and enter your username and password.
  2. Select the Authorize tab (located under the CAQH logo).
  3. Scroll down and select BlueCross BlueShield of Tennessee or you may select Global Authorization.
  4. Select Save to submit your changes.

If you have questions about the CAQH Provider ID, please contact:

CAQH Helpdesk: 1-888-599-1771 | CAQH Email: providerhelp@proview.caqh.org | Website: https://proview.caqh.org


Must be 8 digits

The information in your CAQH ProView profile must match the information on this Provider Enrollment Request. If the information is different, such as specialty, tax identification number or contact information, your enrollment request will be delayed to verify the information.

BCBST will not differentiate or discriminate in the treatment of practitioners or organizations seeking credentialing on the basis of race, ethnic/national identity, gender, age, sexual orientation, religion, patient type (e.g. Medicaid) in which the practitioner specializes.

© BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 1 Cameron Hill Circle, Chattanooga TN 37402-0001