Professional provider credentialing

Credentialing made easier

Credentialing involves two key steps:

1. Apply for credentialing using the Practitioner Participation Form.
2. Any professional provider interested in participating in our network must also complete and return a credentialing application kit. The CAQH ProView^® (CAQH) electronic credentialing application is free to providers and available on the CAQH ProView website.

A summary of the credentialing process

• In addition to your application, you must submit all required supporting documentation. Please ensure you have allowed access to your CAQH application and that it is updated with the correct information and matches what is listed on your Practitioner Participation Form for credentialing.
• Once we have received all required documents, we will review the information on your CAQH application to ensure that it is consistent with the information provided on your Practitioner Participation Form. Please be sure to grant IBX Credentialing permission to view/pull-in your CAQH application.
• Once your credentialing application has been approved, you will receive an email from DocuSign with our standard provider contract, if required.
• You have 30 calendar days from the date of the DocuSign email to electronically sign and return the contract. Please note: If the contract is NOT returned within this time frame, your credentialing application will be rescinded, and you will need to reapply if you still wish to become part of the IBX network.

Network area: Pennsylvania and Delaware

If you have a primary practice address in Pennsylvania or Delaware and would like to join our network(s), you must notify IBX by submitting a Practitioner Participation Form.

Closed networks

The following professional provider networks have participation limitations:

Chiropractic

The chiropractic network is closed to new providers in Pennsylvania and New Castle County in Delaware, except when the provider meets one of the following conditions:

• When the provider is joining an existing participating group;
• When there is a change of control or ownership of the participating provider’s practice, and the participating provider has complied with the terms and conditions of their IBX agreement regarding change of control or assignment, as applicable.

Pathology

The pathology provider network is closed for new office-based pathology providers in the IBX five-county service area (Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) and contiguous counties (i.e., counties that border the IBX five-county service area) except when the pathologist meets the following condition:

• A pathology provider is joining an existing participating hospital-based pathology group in a participating hospital in our five-county service area or a contiguous county (as identified above).

Note: Pathologists cannot be added to participating non-pathology practices.

Podiatry

The podiatry network is closed to new providers except when the provider meets one or more of the following conditions:

• When the provider is located outside of Bucks, Chester, Delaware, Montgomery, and Philadelphia counties;
• When the provider is joining an existing participating group;
• When there is a change of control or ownership of the participating provider’s practice and the participating provider has complied with the terms and conditions of their IBX agreement regarding change of control or assignment, as applicable.

*PNS Contact Tool

For general questions, contact Provider Customer Service at 1-800-ASK-BLUE (1-800-275-2583).

You can also connect with your Provider Network Services (PNS) using the PNS Contact Tool or by submitting a PNS Inquiry Request.