Enrollment and Credentialing

Join the BlueCross BlueShield of Vermont Network

Our network of trusted providers allows us to bring quality care to the communities we serve. To be considered participating with Blue Cross and Blue Shield of Vermont or a designated entity, a group or individual must be enrolled, credentialed and hold a contract. Providers joining existing, contracted groups, or individual providers entering into a contract with Blue Cross and Blue Shield of Vermont, are not eligible to render services to any Blue Cross and Blue Shield member (including Federal Employee Program) until they are fully enrolled and approved by the credentialing committee. 

Get started with your enrollment following the appropriate steps outlined below. You can enroll and submit changes online! If you need help with our online forms, view the online enrollment guide. As part of the enrollment process, you must complete a Council for Affordable Quality Healthcare (CAQH) Credentialing Application.

If you are looking to update to your demographic information, you can make changes to your address, NPI, tax identification number, provider name, or group name using our enrollment change forms.
 

Enrollment Information

Complete and submit the following information for the enrollment process. In addition to the below documents, a contract will be required—we will send you a contract upon receipt of your initial enrollment forms, or you can call (888) 449-0443 (option 2) to get started.

  • Provider Enrollment/Change Form
  • Group Practice Enrollment Change Form
  • W-9 (we require providers to have a Tax Identification Number or EIN; the name reported on the first line of the W-9 will be the name we issue on your 1099 and the name used in our online provider directory)
  • A copy of your state licensure or certificate
  • Board Certification (MD and DO only)
  • Proof of malpractice/liability insurance (minimum of $1m/$3m)
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of the following two links. View our CAQH profile tip sheet
  • Mental health and substance abuse clinicians need to complete the Area of Expertise form to identify their area of expertise for marketing in the Blue national directories.

Completed paper forms and/or required documents should be sent to providerfiles@bcbsvt.com or faxed to (802) 371-3489.

If you are a Dental Practice, you may need to contact various companies for contracts. For more information view our Dental Provider Contract Clarification document.

Complete and submit the following information to enroll with a group:

  • Provider Enrollment/Change Form
  • A copy of your state licensure or certificate
  • Board Certification (MD and DO only)
  • Proof of malpractice/liability insurance (minimum of $1m/$3m)
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of the following two links. View our CAQH profile tip sheet
  • Mental health and substance abuse clinicians need to complete the Area of Expertise form to identify their area of expertise for marketing in the Blue national directories.

Note: We are able to accept enrollment paperwork and begin the enrollment and credentialing process even if a provider is pending issuance of a State of Vermont Practitioner's license. Indicate on the Provider Enrollment/Change Form (PECF) "pending" for license # in Section 4, Provider Information.

Completed paper forms and/or required documents should be sent to providerfiles@bcbsvt.com or faxed to (802) 371-3489. 

Avalon-providers@avalonhcs.comTo establish the group, you must complete and submit the following information. In addition to the below documents, a contract will be required—we will send you a contract upon receipt of your initial enrollment forms, or you can call (888) 449-0443 (option 2) to get started.

If you are a Dental Practice, you may need to contact various companies for contracts. For more information view our Dental Provider Contract Clarification document.

For each provider associated to the group, you also need to complete and submit the following:

  • Provider Enrollment/Change Form
  • A copy of your state licensure or certificate
  • Proof of malpractice/liability insurance (minimum of $1m/$3m)
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of the following two links. View our CAQH profile tip sheet
  • Mental health and substance abuse clinicians need to complete the Area of Expertise form to identify their area of expertise for marketing in the Blue national directories.

Note: We are able to accept enrollment paperwork and begin the enrollment and credentialing process even if a provider is pending issuance of a State of Vermont Practitioner's license. Indicate on the Provider Enrollment/Change Form (PECF) "pending" for license # in Section 4, Provider Information.

Completed paper forms and/or required documents should be sent to providerfiles@bcbsvt.com or faxed to (802) 371-3489. 

To enroll a facility, contact us directly at to providercontracting@bcbsvt.com. We will talk through the contracting and enrollment process.

For enrollment of Locum Tenen, complete and submit the below information:

Locum Tenens who will be covering for another provider for a period of 60 days or less do NOT require credentialing. 

Completed paper forms and/or required documents should be sent to providerfiles@bcbsvt.com or faxed to (802) 371-3489. 

To initiate the contracting process for durable medical equipment, complete and submit the following to providercontracting@bcbsvt.com.

  • Group Practice Enrollment Change Form
  • W-9
  • National Provider identifier (NPI)
  • Proof of liability insurance (minimum of $1m/$3m)

To begin the contracting process, email Provider Contracting at providercontracting@bcbsvt.com, as well as complete the documents noted under the Provider Enrolling with a Group section above, noting “MTM Pharmacist” in the comment note section of the form.

Completed paper forms and/or required documents should be sent to providerfiles@bcbsvt.com or faxed to (802) 371-3489. 

We use a Laboratory Benefit Manager (LBM), Avalon, for our independent laboratory network. To initiate the contracting process, please contact Avalon-providers@avalonhcs.com.

Credentialing Policies

Our credentialing policies define requirement, the process, credentialing and re-credentialing criteria, and rights and responsibilities. View our Provider Policies page to learn more.

Get Help with Provider Enrollment

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