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Contracting Q & As

Here are some answers to questions we frequently get asked about the enrollment process. They are organized by topic.

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Admitting privileges

Do I need admitting privileges?

Please review our credentialing and recredentialing requirements for your specialty to get information on admitting privilege requirements.
Professional Credentialing and Recredentialing Guidelines
Dental Credentialing and Recredentialing Guidelines

Authorized contract signatories

On my Blue Cross Agreement, or contract, it says it needs to be signed by an "authorized signatory"? Does the person who signs a physician contract have to be a physician?

The “authorized signatory” is the person with authority to sign contracts on behalf of the practice (such as Owner, Partner, President). That person should sign, date, and complete the entire left side of the signature page. This person does not have to be a practitioner.

Board certification

Do I need to be board certified?

Some provider types require board certification or have specific training requirements. See credentialing guidelines for details:
Professional Credentialing and Recredentialing Guidelines
Dental Credentialing and Recredentialing Guidelines

Certified registered nurse anesthetist (CRNA) requirements

When should a certified registered nurse anesthetist (CRNA) complete a full application?

If the CRNA is employed by a CRNA practice:

  • They should complete the CRNA contracting application.

If the CRNA is: 1) employed by an ambulatory surgery center, OR 2) affiliated with a physician anesthesiology practice that bills for their services:

  • They should NOT complete the CRNA contracting application.

CRNAs employed by an anesthesiology/MD group practice do not need to be credentialed/contracted by Blue Cross Blue Shield of Massachusetts. CRNAs in this scenario should obtain a non-participating courtesy number for Medicare cross-over claims processing.

Coverage arrangement

Do I need to have a covering arrangement to participate with Blue Cross?

Arranging for coverage after hours and during illness or vacation is a Blue Cross contractual requirement. Covering providers must participate in the same Blue Cross products as you do. See specific requirements for your provider type in the Professional Credentialing and Recredentialing Guidelines

Note: You cannot be your own covering provider. On the application, please do not enter your own name as covering provider.

DEA requirements

When is a DEA certificate required?

If you have prescriptive authority, we’ll need a copy of your Federal Drug Enforcement Administration (DEA) Certificate. (Exception: Optometrists must submit a copy of their Massachusetts Controlled Substances Registration (MCSR).)

Please review our credentialing and recredentialing requirements for your specialty for details about whether a DEA number is required:
Professional Credentialing and Recredentialing Guidelines
Dental Credentialing and Recredentialing Guidelines

Diagnostic imaging services

How do I apply to perform diagnostic imaging services?

If you perform the technical or professional component of diagnostic imaging, you must apply to be privileged. Please complete the privileging application that applies to the services you would like to perform.

If you plan to bill for: Then use the:
Professional component of diagnostic imaging Professional Privileging Application
Technical component of x-rays, ophthalmic A scans, and limited or follow-up obstetrical ultrasounds Limited Technical Privileging Application
Technical component of modalities such as specialized ultrasounds, MRIs, or angiography TDI Privileging Application

For more information, go to the Privileging page.

Error (typo) on contract

My name (or address, license, NPI, etc.) is wrong on the contract. What should I do?

We'll accept corrections to this information only:

  • Incorrect NPI
  • Incorrect license
  • Name spelled wrong
  • Group name spelled wrong

Please cross it out, write in the correct information, and initial the change. We do not accept white-out of information. 

Handicap access

I want to be a participating provider, but my office isn't wheelchair accessible. Can I still submit an application?

To participate with us, the practice does not have to be wheelchair accessible; however, it is preferred.

Hospital-based providers (emergency medicine, radiologists, anesthesiologists, pathologists, nuclear medicine, pediatric radiologists, pediatric anesthesiologists, and pediatric pathologists)

I am a hospital-based provider and do not care for members outside the hospital. Do I need to be credentialed?

You can contract with us without going through the credentialing process, but can only bill for services provided within the hospital. 

If I leave my hospital-based position, do I have to be fully credentialed with Blue Cross Blue Shield of Massachusetts? 
A provider enrolled as a non-credentialed, hospital-based provider who wants to practice outside of a hospital-based setting must be fully credentialed by completing the HCAS form.

Indemnity and PPO participation

If I terminate my PPO contract and still participate in Indemnity products, will I be required to provide care to out-of-state PPO members?

Yes, your contract indicates that you are obligated to see out-of-state PPO members who have a Blue Cross plan. These are BlueCard® program members. You cannot balance bill these patients.

Medicare participation

Am I required to be a Medicare participating provider?

  • Professional providers: No, but you must be eligible to participate with Medicare (that is, not precluded from receiving payment for Medicare Advantage items and services or Part D drugs furnished or prescribed to Medicare beneficiaries).
  • Institutional providers: It depends on your provider type. Please refer to our Institutional
    Credentialing and Recredentialing Guidelines.

My contract

I've sent my application. What comes next?

When you complete an application or an update form for a new contract, we'll ask for the email address of the person who needs to sign the document. (Please use the most current versions of these forms at bluecrossma.com/provider.)

We will use secure email to send you your contract. Please refer to the cover letter we send you that includes detailed instructions on how to return the signed agreement.

Our emails will be sent from bluecrosscontractops@bcbsma.com or Adobe Sign (echosign@echosign.com). If you don’t receive an expected contract, please check your spam folders to make sure that our secure message wasn’t placed there.

If I was sent a contract months ago, can I still send it to you?
If you received the contract more than three months ago, please call 1-800-316-2583 to confirm that the contract is still valid.

If I am opening my own solo practice, do I need to sign Attachment A as well as the signature page?
It depends on your specialty.

  • Physicians, nurse practitioners and physician assistants, including primary care providers, must always sign Attachment A.
  • Solo providers in other specialties are not required to sign Attachment A.

Group practitioners, no matter what specialty, must always sign Attachment A.

What does my contract say about balance billing?
If you are contracted with Blue Cross Blue Shield of Massachusetts, you cannot balance bill our members.

No site address

Can I use a hospital address as my practice location since I don’t have one?

Yes.

NPI

How do I get an NPI, or National Provider Identifier?

Log onto the Centers for Medicare & Medicaid Services (CMS) website at https://nppes.cms.hhs.gov and follow the instructions to apply.

  • Type 1 is for individual health care providers. These include sole proprietors, which are unincorporated businesses that submit claims only for the health care services they render personally. Sole proprietors report income on an individual tax form using their SSN or sole proprietor EIN.
    • Dually licensed: You cannot obtain another type 1 NPI for a different license. When submitting claims, use taxonomy to identify the provider type.
  • Type 2 is for organization health care providers and group practices, which may have a single employee or many. They must have an EIN to obtain a type 2 NPI. This includes incorporated individuals, who are the only employee of the corporation they formed, and who must also have an individual type 1 NPI.
    • Dually licensed: If your practice wants to participate with Blue Cross using an additional specialty type, we strongly recommend you obtain and use a second type 2 NPI on your claims.
Important: Using your NPI(s) on the CMS-1500 claim form or 837P

Individual/sole proprietor
  • Box 24J: Enter your type 1 NPI in the bottom portion as the rendering provider.
    • Dually licensed: If you have Blue Cross contracts for two provider types, enter the taxonomy code for the provider type you are billing in the top portion.
  • Box 33A: Enter your type 1 NPI as the billing provider.
Group practice
  • Box 24J: Enter the rendering provider’s type 1 NPI in the bottom portion.
    • Dually licensed: If the rendering provider is dually licensed, enter the taxonomy code for the provider type you are billing in the top portion.
  • Box 33A: Enter your type 2 NPI as the billing provider.
    • Dually licensed: If your practice has Blue Cross contracts for two provider types, be sure to enter the type 2 NPI for the provider type you are billing.

Nurse Practitioners and Physician Assistants

I am a Nurse Practitioner (or Physician Assistant). How should I contract?

The guidelines below explain how to contract with us.

The following table explains how Nurse Practitioners and Physician Assistants contract with us.

If you: Then you can contract as an/a:
Render primary care Have a collaborating or supervising physician who is listed with Blue Cross as a primary care physician Maintain a panel of patients and manage their care Render specialty care

Yes

Yes

Yes

No

NP-PCP (or PA-PCP)

Yes

Yes

No

No

NP-primary care
(or PA-primary care)

No

No

No

Yes

NP-specialty care
(or PA-specialty care)

Practice changes

I am making changes to my practice. What do I need to do?

Please complete a contract update form for your provider specialty if you are:

  • Leaving your current practice and joining a new one
  • Staying with your current practice and joining a new practice
  • Opening a new practice
  • Changing your practice's Tax ID number
  • Changing your primary care (PCP) status
  • Changing your practice availability
  • Updating your specialty or board certification status
  • Changing a hospital affiliation
  • Adding a product to your Agreement

Please submit a standardized provider information change form  if you are making the following changes to your practice:

  • Changing your practice name, address, phone numbers, email, billing company, access to care or other practice information.
  • Adding a location to a practice that is already contracted with us.

A Practice Application is included in my contracting application. Do I need to submit it? 
If the practice has not already signed a provider agreement, please submit the Practice Application once. If you're joining a practice that already has a contract with Blue Cross, then you don’t need to submit one.

Product selection

Which products should I participate in?

To best serve our members, we encourage you to participate in all the products we offer:

  • HMO Blue
  • Preferred Provider Arrangement, or PPA (also called PPO)
  • Indemnity
  • Medicare Advantage (we offer two Medicare Advantage benefit plans: Medicare Advantage HMO and Medicare Advantage PPO).

Do I have to participate in all products?
For a new contract, you're free to choose which products to participate in, with one exception: for Medicare HMO Blue, our Medicare Advantage product, you also need to participate in HMO Blue (traditional HMO network). If you are joining a group practice, you may be required to participate in the same products as your group or your supervising physician. 

If you decide not to participate in HMO Blue anymore, you will be terminated from Medicare HMO Blue.

Additional note: if you work hand-in-hand with another organization contracted with Blue Cross, we may want both organizations to participate in the same products in order to protect our members from balance billing.

How do I find out which products a provider participates with?
Use our Find-a-Doctor & Estimate Costs tool to review practice information, including network participation. Use the search feature at the top to type in the practice name.

Provider directory

What if my information is wrong in Find a Doctor & Estimate Costs?

It is important that you notify us of any changes to your directory information as soon as possible, especially if the provider is terminating. As you know, your updates are critical so that our members have the most accurate information. On a regular basis, please:

  • Go to Find a Doctor & Estimate Costs.
  • Check the record for all your site locations including telephone numbers, fax numbers, etc.
  • Professional providers: If you need to make changes, use the Standardized Provider Information Change form.
  • Email or fax the form to us.
  • Include if you offer telemedicine since this information is increasingly important to members.
  • Institutional providers: Use the Update Form and fax it to the number on the form.

Start seeing members

When can a practitioner start seeing Blue Cross members?

We will email a new practitioner a welcome letter showing the Blue Cross Product (network) participation and contract effective date; this is when they may begin treating our members.

Whenever you submit an application or request form, be sure to clearly enter the email address where you would like to receive the response.