what is provider recredentialing

Recredentialing of Health Options, Medicare Advantage and NetworkBlue participating providers is performed by BCBSF triennially, in its sole discretion and will require the submission of updated credentialing information. Any such information is reviewed and attempts are made to verify certain information using available third party sources. BCBSF queries the National Practitioner Data Bank or Healthcare Integrity and Protection Data Bank as part of the recredentialing process.

The recredentialing information is reviewed by the Network Management Committee for a final decision regarding continued participation. All such decisions are solely within the discretion of the Network Management Committee.

Publication of Information

Except as may be prohibited by applicable law, BCBSF may publish, in writing or electronically, provider-specific information obtained through the credentialing process or other business processes.

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