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 (IBX) 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 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 (i.e., 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 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 IBX agreement regarding change of control or assignment, as applicable.

Credentialing and recredentialing made easier

It typically takes 90-120 days to complete the credentialing process once IBX has received all requested documentation.

While we remind you to please respond promptly to all inquiries for documentation, we do apologize for the delay and appreciate your patience.

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^® 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. 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 provider participation form for credentialing.
2. Once we have 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 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 30 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 IBX network.

If you have further questions, please email Credentialing Inquiries.

Note: Behavioral Health Providers

Effective January 1, 2023, IBX insourced its behavioral health network and is now directly contracting with behavioral health providers. All providers are required to submit their credentialing information to Independence in order to provide in-network services to our members.

Note: If you have not yet signed an IBX Professional Provider Agreement, you will be considered out-of-network for our members.

Prior participation in Magellan Healthcare, Inc. (Magellan) no longer qualifies providers as an in-network provider.

If you are a behavioral health provider interested in joining our network, the first step is to apply for credentialing. Please complete the online application as thoroughly as required. Applications require timely responses and are closed if the provider does not respond to requests for additional information if needed.

If you do not respond within the designated timeframes, your application will be closed and you will be required to resubmit all information.

Reimbursement terms effective January 1, 2023:

• If you currently participate in the Magellan network but have not signed an IBX Professional Provider Agreement, you will be considered as participating in the IBX network and will be reimbursed in accordance with the terms and conditions specified in the Magellan Professional Provider Agreement up through December 31, 2023.

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

• To confirm if you are already a credentialed provider, you can search for your name on the Commercial or Medicare Advantage Find a Doctor tool.
  • If your name is listed, you do not need to submit a credentialing application or outreach to our credentialing department. However, if you find other provider demographic information is not up to date, please use the online Provider Change Request form. Signing a contract with IBX does not automatically update your demographic data. It must be initiated via this form.
  • If your name is not listed, it means that your credentialing application is still being processed.
• Note: If it has been more than 90 days since you submitted all required credentialing documentation and you wish to check the status of your application, please contact the Provider Partnership Associate (PPA) who covers the county in which your practice is located (see table).

*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.