Certain provider types are recognized as covered providers by Regence BlueShield of Idaho if they meet all of Regence requirements to be eligible as a covered provider. Regence BlueShield of Idaho has established criteria for the evaluation and appointment and reappointment of practitioners and organizations to our network panels. All practitioners requesting participation with us must complete an application for participation, which has been designed to provide the information necessary to perform a comprehensive review of the practitioner’s or organization's credentials. After initial credentialing, recredentialing occurs at a minimum of every three years to verify that the practitioner continues to satisfy all applicable criteria for participation. Please take time to review these important criteria because they may have a bearing on your network participation.

• Practitioner Credentialing Criteria (PDF) (effective November 1, 2007)
• Organizational Credentialing Criteria (PDF) (effective November 1, 2007)

For Provider Agreement information, please contact our Provider Services department at 1 (866) 731-1330 or fax a request to (208) 798-2046.

Change in Participating Effective Date Policy

Effective April 1, 2008, all physicians and other health care professionals must be credentialed before they can participate in a Regence provider network.

Beginning April 1, 2008, the following policy will apply to all participating providers:

• New provider agreements will have an effective date of the first day of the month in which the provider was credentialed (e.g., if credentialing was approved on June 14, the agreement will be effective on June 1).
• If Regence does not receive a signed agreement in the same month as credentialing is completed, the agreement effective date will be the first of the month in which credentialing is approved or the signed agreement is received, whichever is later.
• A new provider joining a group or clinic agreement will have an effective date of the first day of the month in which he or she was credentialed (e.g., if credentialing was approved on June 14, the effective date of participation will be June 1).
• If a provider already participating with Regence adds an additional network, the effective date of the new network will be the first day of the month the signed agreement is received.
• Regence will no longer establish retroactive agreement effective dates.
• Claims submitted to Regence for dates of service prior to the provider’s effective date will be processed as out-of-network.

If you have any questions regarding this policy, please contact your provider consultant,

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