Overview

To become a Blue Shield direct contract provider, please see the instructions, applications and forms below. These materials are applicable to ALL direct contract provider types.

The application process is split into two different steps: 1) credentialing and 2) contracting.

  1. Credentialing: Submit your CAQH request form or completed initial credentialing application to Blue Shield’s Credentialing Department. Credentialing applications and corresponding information are reviewed and formally approved or denied by Blue Shield’s Credentialing Committee. Providers will receive notification when the Credentialing Committee review has been completed. See Step 1 details below.
  2. Contracting: Once Credentialing Committee approval is received, submit the completed Independent Provider Agreement to Blue Shield’s Provider Information & Enrollment Department. To ensure Blue Shield receives all current required documentation, agreements submitted prior to or at the same time as the initial credentialing application will be returned. See Step 2 details below.

Getting started

To learn more about why contracting with Blue Shield is the right decision for your practice, view these documents.

 Who's who in the world of Blue (PDF, 203 KB)

 Blue Shield Independent Physician and Provider Manual

 California Physicians’ Service Blue Shield of California Bylaws (PDF, 102 KB)

Requirements

Read about what we require from our physicians and other healthcare professionals who participate in our Blue Shield Provider Networks.

Step 1: Credentialing

The Council for Affordable Quality Healthcare (CAQH) allows insurance companies to use a single, uniform application for credentialing across Health plans. Blue Shield leverages CAQH as a preferred partner to streamline the credentialing process.

If you are a CAQH participant, please complete the Provider Application Request Form (PDF, 35 KB) and submit the form to BSCCredApps@blueshieldca.com.

Or

If you are not a CAQH participant but would like to become one, please complete the CAQH ProView profile. Once you have registered, complete the Provider Application Request Form Non-CAQH (PDF, 82 KB) and submit the form to BSCCredApps@blueshieldca.com.

Or

If you are not interest in becoming a CAQH participant, please complete the California Participating Practitioner Application (CPPA) and Checklist (PDF, 757 KB). Email or mail the application and all supporting documentation outlined in the checklist to:

 Email: BSCCredApps@blueshieldca.com

Blue Shield of California
      Attn: Credentialing Department
      601 12th Street, 21st Floor
      Oakland, CA 94607

If the required supporting documents are missing or the documents with signature pages are dated more than three months prior to the receipt of the completed application, the Credentialing Department will contact the applicant for the missing information. Failure to submit the information within the third attempt of the Credentialing Department contacting you will be considered a voluntary withdrawal of the application.

If you have previously completed a CPPA for another health plan or medical group, you may submit it for this process. The application must be complete and accurate, dated with a current date, signed, and accompanied by all Blue Shield-required supporting documentation.

The standard turnaround time for processing a complete initial CPPA is between 90 and 120 days. For general inquiries related to the application including status updates, email BSCCredentialingInquiry@blueshieldca.com.

Step 2: Contracting

Download and complete the Independent Provider Agreement (PDF, 198 KB). If needed, Exhibits A and B Explained (PDF 383 KB) will assist you in understanding and completing this section of the contract. In addition, the following documents may be required for contracting:

Submit the completed, signed and unaltered Independent Provider Agreement and all applicable documents listed above to Provider Information & Enrollment by either fax, email or postal mail. If any changes are made to the agreement, it will not be accepted.

Fax: (916) 350-8860

Email: BSCproviderinfo@blueshieldca.com

Blue Shield of California
      Attn: Provider Information & Enrollment
      P.O. Box 629017
      El Dorado Hills, CA 95762-9010

Processing and participation

Blue Shield will assign the effective date for your participating status base upon approval from the Credentialing Committee and the Contracting Department. Services rendered to Blue Shield members prior to this effective date will process as out-of-network.

A copy of the executed Independent Provider Agreement including the assigned effective date will be returned to you after processing. Please contact Provider Information & Enrollment with questions related to your contract at (800) 258-3091 or by email at BSCProviderInfo@blueshieldca.com,

Note: Blue Shield does not contract with ABA Therapy clinicians. Our members receive ABA Therapy services through the Mental Health Service Administrator (MHSA) Magellan ABA Therapy network.

Providers who are interested in joining Magellan's network may call (800) 788-4005 or email CaliforniaProvider@MagellanHealth.com.