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Credentialing Materials

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Physicians and professionals who would like to apply for new participation with us must first complete and return to us a Medical Provider and Behavioral Health Professional Application for Participation Request Form. Once we have received the completed form, we will forward the information to the Council for Affordable Quality HealthCare (CAQH). CAQH will send you a letter with a unique provider ID and instructions to complete the online application called the CAQH Universal Credentialing DataSource. 
The CAQH Universal Credentialing DataSource is now available for the following physicians and allied professionals:  
Advanced practice nurse midwife
Advanced practice nurse practitioner
Chiropractor
Doctor of osteopathic medicine
Medical doctor
Optometrist
Oral maxillofacial surgeon
Podiatrist
 
The following professionals are not required to complete the CAQH credentialing process. Instead, please complete and submit the Medical Provider and Behavioral Health Professional Application for Participation Request Form. Once we receive it, we will mail an Anthem Blue Cross and Blue Shield participation application packet to you.  
Audiologist
Occupational therapist
Physical therapist
Registered dietician
Speech language pathologist
 
All physicians and professionals who wish to participate in the Anthem Blue Cross and Blue Shield managed care network must meet our credentialing policy requirements. Physicians will be required to provide to us a copy of the Maine hospital appointment letter before your application can be considered for credentialing review. 
If you have any questions about the credentialing process, please call us at (800) 832-6011. 
PDF Version: Medical Provider and Behavioral Health Professional Application for Participation Request Form. 

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use