Update issued: April 21, 2020
We have added a clarification to the “Provider audits and claim reviews on hold” section.
This article is for all Blue Cross Blue Shield of Massachusetts professional providers (except dental)
In support of Governor Baker’s public health emergency order to expand access to physician services, we have developed an expedited, time-limited Public Health Emergency Provider Credentialing and Enrollment Process effective immediately.
Fill out our Public Health Emergency Credentialing Application (PHE App) and have an authorized representative of the group you are joining sign and send it back to PHEexpeditedCred@BCBSMA.com. You do not need to complete the Health Care Administrative Solutions (HCAS) enrollment form.
What to expect
- We will make every effort to credential providers within 72 hours from the date Blue Cross receives your application.
- Providers who are approved under this process will receive a Welcome Letter with their effective date. Provider Groups will also be notified daily via the established Massachusetts Hospital Association health plan enrollment notification process.
- Primary care providers will be given a ‘closed panel’ status so members cannot select them as their primary care provider during this temporary period.
- Approval under the Public Health Emergency Provider Credentialing and Enrollment Process is time-limited and pursuant to the Massachusetts state of emergency declaration.
- Providers who are credentialed under this Public Health Emergency Provider Credentialing and Enrollment Process will not appear in our Find a Doctor & Estimate Costs member directory until they have completed the full permanent credentialing process.
When the Massachusetts state of emergency is lifted
- We will notify you following the conclusion of the Massachusetts state of emergency end date of your time-limited credentialing and enrollment with us.
- If you would like to join the Blue Cross of Massachusetts network on a permanent basis you may initiate the full credentialing and enrollment process while concurrently submitting the Public Health Emergency Credentialing application for temporary enrollment. How to apply for full permanent credentialing.
Provider audits and claim reviews on hold
Effective immediately, Blue Cross will be pausing all provider audit and claim review activities for the next 60 days, or for the duration of the state of emergency (whichever comes first). This pause will include activities related to all:
- Retrospective facility (both inpatient and outpatient) and professional provider audits
- Forensic claims prepayment reviews
- Any other claim recovery activities
Please note that we will continue to evaluate paid claims for duplicate payments as well as Coordination of Benefits and Subrogation. Blue Cross also continues to conduct medical reviews and claim recovery activities if there is an indication of potential fraud.
Questions
If you have any questions about this process, please contact your Network Manager or Provider Service at:
1-800-882-2060 (Physicians)
1-800-451-8123 (Hospitals)
1-800-451-8124 (Ancillary Providers)
We value our partnership with you, and we will do everything we can to support you as you care for your patients—our members—under these extraordinary circumstances. Thank you for all you do.
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