How to Fix Delays in Blue Cross Blue Shield Credentialing

Credentialing through Blue Cross Blue Shield (BCBS) is an important step in getting paid by patients with insurance and in ensuring that a provider has access to a large pool of insured individuals. However, while it typically takes about 2 to 3 months, many applications can be delayed by up to six months if no one is actively managing the process. Many providers and hospitals experience significant delays in receiving their Blue Cross Blue Shield credentialing approval, which causes both a lack of reimbursement for services rendered and/or loss of available time slots for new patients scheduled. 

This blog will explain why Blue Cross Blue Shield credentialing delays occur, provide step-by-step ways to address current delays, and offer ideas on how to avoid future delays, all based on experiences from other credentialing processes, including timelines and tips. 

Why BCBS Credentialing Delays Happen 

Blue Cross Blue Shield is not a single national medical insurance company but a collection of 30+ independent plans. Therefore, there is no universal credentialing verification system nor a unified credentialing cycle that all plans operate under. These differences from plan to plan will create uncertainty about how long it will take to complete a credentialing file and thus be a barrier to understanding why a provider’s expectations were not met when they expected a standardized credentialing timeline. 

Additionally, these differences make it difficult to predict how long it will take to complete a credentialing file. While some states typically require 45 to 60 days to credential, others may take longer than 120 days. 

The most common reasons for delay in completing the BCBS credentialing file include: 

• Incomplete and/or old information is contained in the application submitted through CAQH or directly to the payers. 

• Supporting documents (e.g., malpractice insurance and licensure) are missing from an applicant’s file. 

• Delays associated with primary-source verifications by universities and state licensing boards 

• Inconsistent data entry among the National Provider Identifier (NPI), CAQH, and BCBS applications 

• Backlog of payers and delayed review cycles for committees 

Average Credentialing Timeline 

Using the typical Blue Cross Blue Shield (BCBS) credentialing timeline will help you understand how your credentialing is progressing and whether there are any possible delays. 

On average, it takes 60 to 120 days to get credentialed with BCBS, depending on your location.  

• Typically, after submitting a credentialing application, you should receive an acknowledgment within the first two weeks. This initial stage is when BCBS will verify whether your CAQH data, licenses, and taxes can be accessed.  

• The next step, usually taking place within 15 to 60 days, involves verifying your data; during this time, BCBS will review all aspects of your credentialing, including education, board certifications, malpractice insurance coverage, and any past disciplinary action against you.  

• After your file has been verified for completeness, it will then go before a committee for review. A committee reviews credentialing applications at various intervals according to its own schedule. 

• Once your application is approved by the committee, it will proceed to the contracting and network setup phase. During this stage, a provider ID number is generated for each provider and loaded into your billing system.  

However, if it takes longer than 120 days for BCBS to approve your application, it may mean that either you did not provide enough information, it cannot complete its verification of the information provided in your application, or it has a backlog of applications to work through.  

In either case, you would need to confirm that all required information was included in your original application, verify that CAQH has access to the information you provided, and contact your representative at BCBS to obtain a detailed explanation regarding why your application has taken so long. 

Top Reasons for Delays 

Credentialing delays for Blue Cross Blue Shield (BCBS) always stem from an identifiable issue. Below are the top BCBS application delay reasons and what you can do about them.  

Incomplete CAQH Profile 

Your completed CAQH ProView application/profile is the primary source BCBS will use to verify the accuracy of the provider’s information. Regardless of whether your original application was properly completed, an incomplete CAQH application or profile will continue to result in no determination by BCBS. The list of potential challenges includes unsubmitted or expired attachments, unsigned attestations, and unverified work history. 

How to fix it: Log in to your CAQH ProView Account, and check that all fields (education, licenses, malpractice coverage, employment history) are filled out. Prior to the 120-day expiration date of your attestation, re-attempt to complete and verify your CAQH profile. Confirm that BCBS has been granted authorization to view your CAQH Data. If BCBS does not have permission to access your CAQH data, then they cannot initiate verification.  

Missing Documents 

The second leading reason for BCBS to experience delays in processing applications is the lack of adequate supporting documentation. It appears to be a small oversight when providers neglect to provide necessary documentation, such as a current malpractice insurance face sheet, an executed W-9 form, or an accurately prepared Curriculum Vitae (CV) in a format that includes month and year details for education and licensure. 

How to fix it: Organize a digital portfolio of your credentialing documents (medical licenses, DEA certificate, CDS certificate, malpractice certificates, CVs, CLIA (if applicable), and tax documents). Include expiration dates on all files. Signatures should also be included on all submitted forms. A single comprehensive submission of these documents will enable BCBS credentialing specialists to process your application quickly.  

Verification Issues 

At times, everything may appear to be in order on your part. However, Blue Cross Blue Shield (BCBS) has difficulty completing primary-source verifications through state licensing agencies, educational institutions, or previous employers. The state licensing agency, educational institution, or employer may take time to respond, or your records may not correlate with your present data. 

How to fix it: Contact each verification entity, especially state medical boards or colleges/universities, to confirm that your personal and employment information is up to date. If the employer no longer exists or your contact information has changed, consider providing alternative documentation, such as reference letters or prior tax returns, for verification. When contacting BCBS for a credentialing status update, inquire about outstanding verification requests so you can communicate directly with those entities.  

Incorrect Information 

Discrepancy (i.e., a non-matching Taxpayer Identification Number (TIN) between your W-9 and contract or a different business/practice address than your National Provider Identifier (NPI) will result in days or weeks of processing delays. Blue Cross Blue Shield’s credentialing team performs cross-system checks to identify potential inconsistencies that trigger an immediate hold until further clarification is received. 

How to fix it: Prior to submitting, audit all identifying elements to ensure they are consistent throughout all submissions, including your NPI, tax ID number, DEA number, address, etc. Utilize a single master spreadsheet for tracking all credentialing credentials and identifiers used during multiple payer applications (not limited to BCBS) to fix credentialing delays.   

Slow Payer Response 

Sometimes the problem is not related to your submission. It may be due to how long BCBS credentialing teams take to process their files. Delays may occur in meetings with committees or simply due to administrative workloads that cause files to become delayed or placed at the bottom of the queue. Unfortunately, these types of delays are usually difficult to resolve. 

How to fix it: Regularly send follow-up emails every 2 weeks, requesting a status update with committee notes. Ensure that your email contains the provider’s NPI, submission date, and contact details. Documenting all your communications (emails) may create a paper trail, which can help to establish accountability and most likely encourage faster response. 

Step-by-Step Solutions to Fix Delays 

If your Blue Cross Blue Shield (BCBS) credentialing file has been pending longer than 90 or 120 days, follow this structure to expedite the process. 

• Confirm receipt: Contact BCBS’s provider enrollment support to confirm your file was received. Many times, delays occur due to submission to the wrong portal. 

• Audit your CAQH profile: Verify that it is current and recently re-attested. Expired attestations are typically in the top three reasons for delayed BCBS credentialing. 

• Check your documentation packet: Check each item in it. Replace outdated items and double-check your licensure verification, malpractice coverage, and business practice address listings. 

• Request internal status notes: When contacting your BCBS representative, ask them to provide an internal status note listing the stage your file is in, such as verification, review, or contracting. 

• Respond within 24 hours: Each time you respond slowly to requests or corrections from your representative, it adds to the total processing time for your file. Credentialing communication should be a priority until it is resolved. 

• Bundle updates carefully: When submitting additional information to correct errors, submit all necessary documentation in a single packet rather than in separate packets. This eliminates unnecessary confusion and promotes efficiency. 

• Confirm upcoming committee meetings: Find out when the next credentialing committee meeting is scheduled. Determine if your file is listed on the agenda. Delayed approval may result from missing one cycle. 

• Escalate as needed: If your file remains unresolved after 120 days, escalate the issue to your supervisor through provider relations. Documented, calm escalation promotes progress on stalled files. 

• Work with a credentialing expert: Professional enrollment specialists like Credex Healthcare have experience working with BCBS systems. They can help significantly expedite the processing times. 

How to Track Your Application Status 

Tracking your progress with Blue Cross Blue Shield (BCBS) after submitting your application is important. Most BCBS divisions offer online portals where you can track your application status. The most common application statuses are ‘Received, In Process,’ ‘Pending Committee Review,’ or ‘Approved.’ 

If you do not have access to a portal, you should periodically request, via e-mail or telephone, contact information from the Blue Cross Blue Shield representative, as they will be able to tell you what has been done in processing your application. As you are waiting for responses regarding the status of your application, keep an eye on your CAQH Dashboard. BCBS usually updates its status before sending an official notification e-mail. Keep an accurate record of the date, time, and names of the people you have contacted, including the comments made during your communication. This type of documentation will help you record any delays in the process.

When to Use Credentialing Experts 

There are times when the effort you put into the process still may not speed it up. It is those times when working with a payer enrollment specialist or credentialing expert may provide what you need. These professionals work directly with BCBS representatives daily and understand the documentation requirements for each region’s Blue Cross Blue Shield plans.  

A credentialing expert will verify that your CAQH is accurate, that your application is complete and has been reviewed thoroughly, and that all communications occur as efficiently as possible. Additionally, a credentialing expert like Credex Healthcare may be able to resolve any issues stalling your application in a relatively short period (usually 15 to 30 days), as they are familiar with the internal review process and know who to contact to escalate the issue.  

Depending on your specialty and patient load, losing one week of revenue per month while awaiting credentialing could cost you thousands of dollars. Working with a credentialing expert will pay for itself by allowing you to begin billing as soon as possible.  

FAQs 

Why is my BCBS credentialing taking so long? 

There are several reasons why a credentialing process may be delayed. BCBS credentialing processes can take time as they often require updates to your (or provider’s) CAQH information. The application for BCBS credentialing requires all providers to submit their completed application forms to complete. Due to high volumes of applications at each local BCBS office, there will be times when it takes longer than usual for an application to be processed. 

Can I speed up the credentialing process? 

Yes. There are several things that you can do to potentially accelerate the credentialing process. For example, you will want to ensure your CAQH profile is always up to date. In addition, you will need to ensure that all licenses and other insurance-related documentation are valid (e.g. certifications). Credentialing consultants like Credex Healthcare are available to assist in coordinating with the BCBS enrollment team to expedite your credentialing decision. 

What if I have submitted everything but still haven’t heard back? 

After waiting 90 days, submit a request to receive your application status notes from BCBS. Your application status notes provide insight into where your application stands in the credentialing approval cycle. Specifically, these notes indicate whether your application has been placed on hold pending additional verification, whether it has been reviewed by the committee, or whether contract setup is required before your provider agreement will be approved, thereby providing you with clarity on why the delay has occurred. 

Conclusion  

Delayed Blue Cross Blue Shield (BCBS) credentialing is far more common among healthcare provider organizations than many have come to believe; however, both issues with delays that occur in credentialing processes can be resolved. Most of these problems stem from inconsistent data entry across one or more systems, missing documentation supporting an individual’s eligibility for payment, and delayed communication among the parties involved. 

By utilizing a structured credentialing method that includes maintaining current CAQH information, verifying all patient demographic and clinical information in all applicable systems, communicating strategically at each step of the credentialing process, and escalating the issue if no resolution has occurred within a reasonable timeframe, you can minimize the length of your BCBS credentialing delay significantly. A well-structured credentialing approach works regardless of whether you’re a small, independent physician or part of a large multispecialty medical group. Therefore, it ensures continuous cash flow and smooth operational performance of your organization. 

Therefore, if your BCBS credentialing is delayed beyond 90 days, it is critical that you take action immediately, review what may have caused this delay, follow up with those who were responsible for completing the steps needed to complete the credentialing process, and do not hesitate to utilize professional assistance to expedite your credentialing process.