Regence BlueShield contracts with physicians, other health care professionals and facilities to form provider networks essential for delivery of health-care services to our members. All physicians and other health care professionals must be credentialed before they can participate in Regence provider networks. View a list of open provider types/panels with whom we contract. Learn more about our Credentialing (PDF) process.
For more information or to request an application, please contact your Provider
Consultant.
Regence BlueShield opens Physicial Therapy network panel
Beginning September 1, 2009 Regence BlueShield will be opening the Physical Therapy Network to new applicants. Physical Therapists who are not currently participating providers are eligible to apply. Learn more.
| Provider |
Definition |
Criteria |
Forms |
| Practitioners |
Physicians and other health care professionals.
Indian or Tribal Health Clinic credentialing requirements
Effective January 1, 2009 Regence will require that all Indian/Tribal Health Clinic providers complete the credentialing process prior to contracting. Indian/Tribal Health Clinic providers will also be required to go complete the recredentialing process at a minimum of every three years. |
Practitioner
Credentialing Criteria for Participation and Termination (PDF)
(effective 1/1/2009)
|
Washington
Practitioner Application (2007 version) (PDF)
Send completed forms to P.O. Box 21267, Mail Stop S916, Seattle, WA 98111-3267.
W9 form and instructions |
| Organizations |
Eligible organizational providers include:
- Ambulatory Surgery Centers
- Hospital Medical Centers
- Home Health Agencies
- Hospice Care Centers
- Skilled Nursing Facilities
- Behavioral Health Care Organizations, including those that provide mental health, chemical dependency, alcohol and drug rehabilitation services.
|
Organizational
Provider Credentialing Criteria for Participation and Termination (PDF)
(effective 1/1/2009)
|
Request an Organizational Provider
Application from your Provider
Consultant.
Send completed form to P.O. Box 21267, Mail Stop S916, Seattle WA
98111-3267
W9 form and instructions |
| Facilities |
|
|
Universal
Facility Application (PDF)
Send completed form to P.O. Box 21267, Mail Stop S916,
Seattle WA 98111-3267. |
| Hospital-Based
Practitioner Information Form |
Hospital-Based
Practitioner Information Form (PDF) |
Use this form when a provider is being added
to a hospital-based facility. Regence
BlueShield defines Hospital Based Practitioners
as, “Practitioners
who practice exclusively within a hospital setting,
meets our credentialing and contracting criteria
and provides care for Regence
BlueShield members
only as a result of members being directed to the
hospital or other inpatient setting." |
Indian or Tribal Health Clinic credentialing requirements
Effective January 1, 2009 Regence will require that all Indian/Tribal Health Clinic providers complete the credentialing process prior to contracting. Indian/Tribal Health Clinic providers will also be required to go complete the recredentialing process at a minimum of every three years.
Change in Participating Effective Date Policy
Effective April 1, 2008, all physicians and other health care professionals must be credentialed before they can participate in a Regence provider network.
Beginning April 1, 2008, the following policy will apply to all participating providers:
- New provider agreements will have an effective date of the first day of the month in which the provider was credentialed (e.g., if credentialing was approved on June 14, the agreement will be effective on June 1).
- If Regence does not receive a signed agreement in the same month as credentialing is completed, the agreement effective date will be the first of the month in which credentialing is approved or the signed agreement is received, whichever is later.
- A new provider joining a group or clinic agreement will have an effective date of the first day of the month in which he or she was credentialed (e.g., if credentialing was approved on June 14, the effective date of participation will be June 1).
- If a provider already participating with Regence adds an additional network, the effective date of the new network will be the first day of the month the signed agreement is received.
- Regence will no longer establish retroactive agreement effective dates.
- Claims submitted to Regence for dates of service prior to the provider’s effective date will be processed as out-of-network.
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