Credentialing is the process by which Blue Cross and Blue Shield of Oklahoma (BCBSOK) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet professional standards. With certain exceptions, such as Tribal providers, all contracted providers must be credentialed with BCBSOK. This includes hospital-based providers, including but not limited to those with a specialty of anesthesia, radiology, pathology, and emergency medicine. As a reminder, all contracted providers will be listed in the BCBSOK provider directory pursuant to the requirements of federal and state law.
Also, effective Nov. 1, 2023, BCBSOK is happy to announce we are implementing Provisional Credentialing. Upon receipt of a completed CAQH application, we will perform an initial review and if certain criteria are met, the provider will receive Provisional Credentialing Approval. This process allows BCBSOK to contract and load applicable networks into our system in an expedited manner. All such providers are still subject to the full credentialing process and if not approved, the applicable network contracts will be terminated. Provisional Credentialing allows eligible providers network participation to begin seeing members sooner.