Managed Care Provider Directory - Blue Cross and Blue Shield of ...

Summarization of Individual Provider Credentialing StandardsCredentialingCredentialing standards are the criteria certain network providers must meet andmaintain to be accepted as a participating provider or to continue as networkproviders. The credentialing process takes an average of 45 days to complete.Credentialing application information is verified with the primary source within180-days prior to making any credentialing decision. After verifying the minimumeligibility criteria, the BCBSMT Credentialing Committee considers the provider'scredentials based on specific criteria. The committee consists of physicians andnon-physicians, representing multiple specialties from across Montana, andrepresentatives from BCBSMT.Re-CredentialingRecredentialing is performed every three years and requires an updated providerapplication and reverification of all of the information except the provider's initialeducation and training. If information is received that raises quality concerns prior torecredentialing, the provider's participation may be reconsidered.State licensing board continuing education requirements are followed for all providerswith the exception of physicians. Physicians are required to complete 75 Category Icontinuing education credits within three years.LicensureSource of Information· Provider Credentialing Application· Appropriate State Board of Medical ExaminersStandardThe provider has a valid and current license to practice in the state of Montana.