Professional provider credentialing

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 Independence Blue Cross (Independence) by following the steps below.

Closed networks

Chiropractic

The chiropractic network is closed to new providers in Pennsylvania and through 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 Independence agreement regarding change of control or assignment, as applicable.

Pathology

The pathology provider network is closed for new office-based pathology providers in the Independence five-county service area (i.e., Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) and contiguous counties (i.e., counties that border the Independence 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 in counties outside of Chester, Montgomery, Delaware, Philadelphia, and Bucks 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 Independence agreement regarding change of control or assignment, as applicable.

Credentialing and recredentialing made easier

It typically takes 30-60 days to complete the credentialing process once Independence has received all requested documentation.

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 electronic credentialing application is free to providers and available on the CAQH ProView website.

Learn more about our credentialing criteria.

Save time

If you are filling out paper forms, completing the credentialing process can take hours. This is especially true if your practice contracts with multiple health plans. The CAQH ProView online application minimizes the time it will take to complete this administrative work by eliminating the need to fill out multiple, redundant, and time-consuming forms.

Save money

The CAQH ProView online application is entirely free to providers and helps practices save money on administrative resources.

Keep your information current

Keeping your practice information up-to-date isn’t just important for credentialing purposes — it’s important for health plan records and directories, too. The CAQH ProView online application makes it quick and easy for you to stay current by allowing you to update only the information that needs to change. There’s no need to resubmit information that should stay the same.

A summary of the credentialing process

1. In addition to your application, you must submit all required supporting documentation. Independence will provide an email outlining what documents are needed.
2. Once Independence has received all required documents, we will review the information on your CAQH ProView® application to ensure that it is consistent with the information provided on your Practitioner Participation Form. Please be sure to grant Independence Credentialing permission to view/pull-in your CAQH application.
3. Once your credentialing application has been approved, you will receive an email from DocuSign with the standard contract, if required.
4. You have 15 business 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 Independence network.

If you have further questions, please email Credentialing Inquiries.

Note: Behavioral Health Providers

Independence currently works with Magellan Healthcare, Inc. (Magellan) to provide a behavioral health network to its members. Effective January 1, 2023, we are insourcing the network and are directly contracting with behavioral health providers.

If you have not yet signed an Independence Professional Provider Agreement but are currently participating with Magellan, you will be considered in-network for our members and will continue to be reimbursed according to Magellan’s reimbursement terms. If you would like to receive an enhanced reimbursement under the terms of the Independence Professional Provider Agreement, please follow the process outlined below.

If you are a behavioral health provider interested in joining our network:

Behavioral health practitioners joining existing contracted groups

• If you have a new practitioner joining a Contracted Group contracted with Magellan, or contracted with both Magellan and Independence, please submit all credentialing material to Magellan.
• If you have a new practitioner joining an Independence contracted group that does not contract with Magellan, initiate the credentialing process at Independence by applying for credentialing.

Note: While Independence transitions to a directly contracted behavioral health network, behavioral health providers contracted with Magellan will continue to be considered in network through 2023. If you have any questions related to your Magellan agreement, you can contact Magellan Provider Services Line at 1-800-788-4005 for assistance.

Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most Independence members.

Reimbursement terms effective January 1, 2023:

• If you currently participate in the Magellan network but have not signed an Independence Professional Provider Agreement, you will be considered as participating in the Independence network and will be reimbursed in accordance with the terms and conditions specified in the Magellan Professional Provider Agreement.
  
  While you will maintain your in-network participation status to provide services to Independence members, you will not be eligible for the Independence terms and conditions (including provider appeal rights and the enhanced Independence reimbursement) until at which time you sign an Independence Professional Provider Agreement.

Please refer to the steps above to complete the contracting/credentialing process.