Recredentialing & Credentialing Applications

Recredentialing for existing providers

Credentialing and Recredentialing Policy

Recredentialing (Practitioner)

Recredentialing Application (Practitioner)

CAQH

If you are currently maintaining a credentialing application on CAQH ProView™ that you would like us to use, you can email your CAQH ID to us at prov.net@bcbsnd.com.

Credentialing for new providers/facilities

Credentialing (Practitioner)

Are you new to the North Dakota area or have you recently graduated? If so, please complete the appropriate professional application below.

Credentialing Application (Practitioner)

Credentialing (Facility/Organization)

Ambulance Credentialing Application
Behavioral Health – Institutional Provider Credentialing Application
Durable Medical Equipment Credentialing Application
Healthcare Organization Credentialing Application Use this form for all other specialities.
Home Infusion Credentialing Application
Medication-Assisted Treatment Facility Credentialing
Optical Supplier Credentialing Application
Public Health Unit Credentialing Application

Dental Provider Applications
Apply to become a UCD network dental provider.
BCBSND's partners with United Concordia Dental for network management (provider contracting), claims administration and member/provider customer service.

Our products continue to be Blue branded and we partner with United Concordia to develop and market dental products.

Vision Provider Applications
Apply to become a vision provider.

BCBSND partners with Vision Service Plan (VSP) for network management (provider contracting), claims administration and member/provider customer service.

Our products continue to be Blue branded and we partner with VSP to develop and market vision products.

Medicaid Expansion Program
If you are not already a credentialed BCBSND provider, get started by completing the applicable form(s) above. If you are already credentialed and want to be a part of the Medicaid Expansion network, request an addendum by sending an email to providercontracting@bcbsnd.com. 1915(i) non-emergency medical transportation and meal and lodging providers can be credentialed through the State of North Dakota.

Providers who bill as a rendering/performing provider on claims (including Pharmacists) need to complete the Practitioner Credentialing Application found above.

Other participation and credentialing resources

Availity Essentials

The following forms are located in Availity Essentials within the Payer Spaces under the Resources tab:

Electronic Remit and EFT requests can be submitted through Availity Essentials under My Providers, then Enrollment Center.