Contracting, Enrollment, Credentialing & Demographic Changes

Enroll or Submit Changes Online!

Enroll or make changes to your existing information online, with our new online tools:

Online PROVIDER Enrollment/Change Form (PECF)

Online GROUP Enrollment/Change Form (GECF)


Please review the details and requirements related to each enrollment option.

For an overview of the tool, including required fields and how to attach required documentation, use the online enrollment tool quick reference guide.

Requirements

To be considered participating with BCBSVT or a designated entity, a group or individual must be enrolled, credentialed and hold a contract. Providers joining existing, contracted groups or individual providers entering into a contract with BCBSVT are not eligible to render services to any Blue Cross and Blue Shield member (including Federal Employee Program) until they are fully enrolled and approved by the credentialing committee.
 

What information are you looking for?


Provider Enrolling with a Group

You must complete and submit the following:

  • Provider Enrollment/Change Form (PECF) Online Form | Paper Form
  • A copy of your state licensure or certificate
  • Proof of malpractice/liability insurance
    • Minimum of $1m/$3m
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of these two links:


Note: We are able to accept enrollment paperwork and begin the enrollment and credentialing process even if a provider is pending issuance of a State of Vermont Practitioner's license. Indicate on the Provider Enrollment/Change Form (PECF) "pending" for license # in Section 4, Provider Information. 

 

Credentialing

You must complete a Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of these two links:


For BCBSVT credentialing, the first step is to complete or update a CAQH application. Read more about credentialing.

 

Credentialing Policy:

The BCBSVT Credentialing Policy includes details of the credentialing process for hospital based providers, credentialing and re-credentialing criteria, verification process, quality review and credentialing committee review, acceptance to the network, ongoing monitoring, confidentiality and practitioner rights in the credentialing process. The policy is located within the secure Provider Resource Center under BCBSVT Policies the Quality Improvement link. Or, if you are not yet a provider with BCBSVT, contact the provider relations team at (888) 449-0443 for a paper copy.

Credentialing Rights:

Your rights during the credentialing process are outlined below.

  • To receive information about the status of the credentialing application on request. Upon request for information, the credentialing coordinator will inform you of the status of your credentialing application and the anticipated committee review date.
     
  • To review information submitted to support the credentialing/re-credentialing application. You may request to review the information submitted in support of the credentialing application. Upon request, you will have the opportunity to review non-peer protected information in the credentialing file during an agreed upon appointment time. The appointment time will be during regular business hours in the presence of the credentialing coordinator.
     
  • To correct erroneous/inaccurate information. The Plan will notify you in writing if information on the application is inconsistent with information obtained via primary source verification. You have the right to correct erroneous information received from verification sources directly with the verifying source. You must respond to the Plan in writing to address any conflicting information provided on the application. We will review your response to ensure resolution of the discrepancy. We evaluate all applications against Plan criteria and may require a credentialing committee review if your application does not meet Plan criteria.

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Independent Provider

You must complete and submit the following:

  • Provider Enrollment/Change Form (PECF) Online Form | Paper Form
  • Group Practice Enrollment Change Form (GPECF) Online Form | Paper Form
  • W-9
  • A copy of your state licensure or certificate
  • Proof of malpractice/liability insurance
    • Minimum of $1m/$3m
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of these two links:

In addition to the above documents, a contract will be required. Call (888) 449-0443, option 2.

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New Group Practice with Associated Providers

To establish the group, you must complete and submit the following:

In addition to the above documents, a contract will be required. Call (888) 449-0443, option 2.

 

For each provider associated to the group, you must complete and submit the following:

  • Provider Enrollment/Change Form (PECF) Online Form | Paper Form
  • A copy of your state licensure or certificate
  • Proof of malpractice/liability insurance
    • Minimum of $1m/$3m
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of these two links:

 

Note: We are able to accept enrollment paperwork and begin the enrollment and credentialing process even if a provider is pending issuance of a State of Vermont Practitioner's license. Indicate on the Provider Enrollment/Change Form (PECF) "pending" for license # in Section 4, Provider Information.

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Enrollment of Locum Tenen

You must complete and submit the following:

  • Provider Enrollment/Change Form (PECF) Online Form | Paper Form
  • A copy of your state licensure or certificate
  • Proof of malpractice/liability insurance
    • Minimum of $1m/$3m
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)

Locum Tenens who will be covering for another provider for a period of six months or less do NOT require credentialing.

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Durable Medical Equipment

To initiate the contracting process, you must complete and submit the following:

  • Group Practice Enrollment Change Form (GPECF) Online Form | Paper Form
  • W-9
  • National Provider Identifier (NPI)
  • Proof of liability insurance
    • Minimum of $1m/$3m

All enrollment documentation must be submitted to :

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Demographic Changes

Complete the Online Group Enrollment Change Form and be sure to attach any additional documents, as noted below.

Group

  • Address Change or New NPI
  • New Tax ID or Group Name Change
  • Address Change for Provider(s) Associated with Group
  • Name Change for Provider(s) Associated with Group
    • Copy of State licensure or certificate


Independent Provider(s)

  • Address Change or New NPI
  • New Tax ID or Group Name Change
  • Provider Name Change
    • Copy of State licensure or certificate

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Paper Forms

We highly recommend the online enrollment/change form option. However, if you wish to complete and mail in paper forms, you are welcome to do so using the forms below:

 

Where to submit completed enrollment forms and required documentation:

Type of ChangeWhere to Send
Durable Medical Equipment and
Laboratory Providers

 

Email: providercontracting@bcbsvt.com

All Other Changes

Fax: (802) 371-3489

Email: providerfiles@bcbsvt.com