Credentialing is the process by which Blue Cross and Blue Shield of Oklahoma (BCBSOK) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards.
Effective May 17, 2010, the Council for Affordable Quality Healthcare, Inc. (CAQH) will collect the data required for our credentialing and recredentialing process. CAQH uses a Universal Provider Datasource® (UPD) form to electronically collect the data. This online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database. Providers may utilize the UPD at no cost.
The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH is solely responsible for its products and services, including the Universal Provider Datasource.
Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following:
- Right to review information submitted on or with their credentialing and recredentialing application;
- Right to correct erroneous information;
- Right to be informed of the status of their credentialing or recredentialing application, upon request.
Applicants should direct all requests to their Network Management Representative. The Enterprise Credentialing Department will notify the Applicant in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be given sufficient time to correct erroneous information and resubmit to the Enterprise Credentialing Department. It will be the Applicant's responsibility to work directly with the reporting entity(ies) to correct the erroneous information.
All BCBSOK providers must have a CAQH Provider ID to register and begin the credentialing process.
First time CAQH users
- If you are not registered with CAQH and are a first-time user, when you apply for network participation, we will add your name to our roster with CAQH. CAQH will mail you access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate online access to the UPD.
- When you receive your CAQH Provider ID, go to the CAQH website to register. After validating key information, you will be able to create your own user name and unique password to begin using the UPD database.
- Once registration is completed, you may use your user name and password to log in at any time.
Existing CAQH users
- If you are already registered with CAQH through another health plan, log in to the UPD and add BCBSOK as one of the health plans that can access your information.
- Go to https://upd.caqh.org/OAS/ (type address into browser), and enter your username and password.
- Click the "Authorize" tab located under the CAQH logo.
- Scroll down, locate BCBSOK, and check the box beside BCBSOK. You may also select "global authorization." If you have chosen "global authorization," then BCBSOK will already have access to your data.
- Click “Save” to submit your changes.
|Help Desk||(888) 599-1771|
|Online Application System URL||https://upd.caqh.org/oas/|
|Help Desk E-mail Addressemail@example.com|
|Help Desk Hours||6 a.m. to 8 p.m., CT, Mon. – Thurs.|
|6 a.m. to 6 p.m., CT, Fri.|
|Fax Supporting Documentation to:||(866) 293-0414|
|Alternate Fax:||(866) 293-0416|
|Email Supporting Documentation to:||firstname.lastname@example.org|
The UPD standardized application is an online form that meets the needs of all participating health care organizations. When completing the application, you will indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the UPD service is maintained by CAQH in a secure, state-of-the-art data center.
When you are ready to begin entering your data, log in to the UPD with your user name and password.
The following materials are helpful to reference while applying:
- Previously completed credentialing application
- List of previous and current practice locations
- Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc.)
- State medical license(s)
- Curriculum Vitae
- Drug Enforcement Administration Certificate
- Controlled and Dangerous Substances Certificate
- IRS Form W-9(s)
- Malpractice insurance face sheet
- Summary of any pending or settled malpractice cases
After completing the application, you will also be asked to:
- Authorize access to your information – List the organizations that you would like to receive your information. You may select "BCBSOK" or "global authorization."
- Verify your data entry – Review a summary of your data for completeness and to make any changes as necessary.
- Submit supporting documents – To complete your application, fax the supporting documentation to CAQH at (866) 293-0414.
If you have any questions on accessing the UPD database, you may contact the CAQH Help Desk at (888) 599-1771 for assistance.
BCBSOK may need to supplement, clarify, or confirm certain responses on your application with you. Therefore, you may be required to provide us with supplemental documentation in some situations, in addition to the information you submit through the UPD. You will receive notification if any additional information is needed by BCBSOK.
Visit the CAQH website for more information about the UPD and the application process. You may also contact your BCBSOK provider representative with any questions regarding this new procedure.
Checklists and Requirements are subject to change without any notice.
- Health Care Professional Application Checklist
- Health Care Professional Credentialing Requirements
- Primary Care Specialist Credentialing Requirements
- Physician Application Checklist
- Recredentialing Application Checklist
- Recredentialing Requirements
- Specialist Credentialing Requirements
Additional Forms Required by BCBSOK for Credentialing
If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete the form(s) and forward to BCBSTX:
- Hospital Coverage Letter – required to be submitted to BCBSOK for those providers who do not have admitting privileges at a participating network hospital.
- APN Supplemental Questionnaire – Prescribing Authority – required for a APN who plans to prescribe controlled substances and holds a current DEA and State Controlled Substance Certificate.
- PA Supplemental Questionnaire – Prescribing Authority – required for a PA who plans to prescribe controlled substances and holds a current DEA and State Controlled Substance Certificate.
- Supervising Physician and Protocols & Duties Supplemental Questionnaire – required for Physician Assistant to provide the name of their Supervising Physician and attest to having protocol/duties.
- APN Supervising Physician and Protocols & Duties Supplemental Questionnaire – required for APN to provide the name of their Supervising Physician and attest to having protocol/duties.
Keeping your information current is your responsibility. You will be sent automatic reminders to review and attest to the accuracy of your data. Use the CAQH database to report any changes to your practice, in accordance with the time frames outlined in the State of Oklahoma.
You must enter your changes into the UPD database for us to access. Only health plans that participate in the UPD and that have been authorized by you to access your information will receive any changes.
CAQH requires you to review and attest to your data once every four months. At the time you are scheduled for recredentialing, BCBSOK will send your name to CAQH to determine if you have already completed the UPD credentialing process. If so, we will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you. The process of recredentialing is identical to that for credentialing and is consistent with URAC and State of Oklahoma requirements.
If your application is not available to BCBSOK, you will be added to our roster. CAQH will send you a registration letter and a CAQH Provider ID so that you can complete the UPD credentialing process. This will help you continue to conform to the requirements of your BCBSOK contract.