Update: Changes to Practitioner Board Certification Requirements

July 14, 2023 Update: The following information is an update to the original posting. 

Blue Cross NC acknowledges that some providers may have circumstances where the Board eligibility requirements take longer than three (3) years for completion for all providers obtaining that Board certification. For example, but not limited to, certain fellowship training requiring longer than three (3) years, and foreign national physician candidates working towards Board certification. This does not apply when a provider can obtain their applicable Board certification within three (3) years but do not complete it within that time. Any provider with a Board eligibility requirement of longer than three (3) years shall communicate that to Blue Cross NC at the time their applicable initial or recredentialing application is filed. For all credentialing through delegated entities, providers shall provide this same information to their delegated entity when applicable, and delegates shall keep delegation files updated to note and inform Blue Cross NC of any providers falling within the special Board eligibility circumstances above. 

Effective 4/30/2023: All credentialing physicians must be board eligible/certified.

All initial credentialing files for Physicians 

• Any MD/DO that is Board Eligible may apply for credentialing with Blue Cross NC networks with the express condition that they must become Board Certified by American Board of Medical Specialties (ABMS) or American Board of Osteopathic Association (AOA) within three (3) years from their initial credentialing date. 
• Any MD/DO that was Board Eligible upon their initial credentialing approval that fails to obtain their Board Certification within the three (3) years after their initial credentialing shall be immediately decredentialed and terminated from any Blue Cross NC networks. 
• Any MD/DO that has been decredentialed for failure to obtain appropriate Board Certification shall have any future credentialing requests to Blue Cross NC denied until such time as appropriate Board Certification is obtained.   
• Any MD/DO that is Board Eligible upon initial credentialing and obtained their Board Certification within the required three (3) year deadline, shall be eligible for recredentialing with Blue Cross NC. 
• All MD/DOs will be credentialed in the respective field in which they are Board Eligible/Certified to practice based on the application information submitted by the MD/DO. 
• Any MD/DO with Board Eligibility in two (2) or more specialties may apply for credentialing with Blue Cross NC, with the express condition that they become Board Certified for each specialty within three (3) years of their initial credentialing by The American Board of Medical Specialties (ABMS) or The American Board of Osteopathic Association (AOA). Any MD/DO that does not obtain appropriate Board Certification within that three (3) year period shall be immediately decredentialed and terminated from any Blue Cross NC networks for specialties in which Board Certification was not obtained.   

All recredentialed files for Physicians 

• All MD/DOs that were Board Eligible and credentialed with Blue Cross NC April 30, 2023 or earlier are grandfathered in for Blue Cross NC credentialing, and do not have to obtain their Board Certification as required for initial credentialing files.  Nothing prohibits any Board Eligible MD/DO covered here from obtaining Board Certification and updating their Blue Cross NC file. 
• Should any recredentialed MD/DO currently grandfathered become decredentialed with Blue Cross NC for any reason, and then later reapply for credentialing, the MD/DO shall be treated as an initial practitioner credentialing, and the terms for initial credentialing files in the bullet points section above shall apply.