Enrollment and Credentialing

Join the BlueCross BlueShield of Vermont Network

Our network of trusted providers allows us to bring quality care to the communities we serve. To be considered participating with Blue Cross and Blue Shield of Vermont or a designated entity, a group or individual must be enrolled, credentialed and hold a contract. Providers joining existing, contracted groups, or individual providers entering into a contract with Blue Cross and Blue Shield of Vermont, are not eligible to render services to any Blue Cross and Blue Shield member (including CBA Blue, the Federal Employee Program and Vermont Blue Advantage) until they are fully enrolled and approved by the credentialing committee. 

Credentialing and Recredentialing is done by Verisys, a national credentials verification organization.

Get started with your enrollment following the appropriate steps outlined below. You can enroll and submit changes online! If you need help with our online forms, view the online enrollment guide. As part of the enrollment process, you must complete a Council for Affordable Quality Healthcare (CAQH) Credentialing Application.

You will also need to make sure your National Plan and Provider Enumeration System (NPPES) file is up to date - practice location(s), taxonomy, phone number, etc. NPPES is located at: https://nppes.cms.hhs.gov/#/.

If you are looking to update to your demographic information, you can make changes to your address, NPI, tax identification number, provider name, or group name using our enrollment change forms.

Our Enrollment and Credentialing policies define requirements, the process, credentialing and re-credentialing criteria, and rights and responsibilities. Find them on our Provider Policies page to learn more.

Enrollment Information

Complete and submit the following information for the enrollment process. In addition to the below documents, a contract will be required—we will send you a contract upon receipt of your initial enrollment forms, or you can call (888) 449-0443 (option 2) to get started.

  • Solo/Individual/Independent Provider Enrollment/Change Form
  • If you have a specialty that is recognized by CMS to see Medicare and Medicare Advantage members, then you must either be enrolled or opted out of Medicare.
  • IRS Form SS-4 notice (provides verification of EIN). The business name reported on the SS-4 notice will be the name we issue your 1099 and the name used in our online provider directory.
  • A copy of your state licensure or certificate
  • Board Certification (MD and DO only)
  • Proof of malpractice/liability insurance (minimum of $1m/$3m)
  • Any applicable board certification or Drug Enforcement Agency license
  • National Provider Identifier (NPI)
  • Council for Affordable Quality Healthcare (CAQH) Credentialing Application using one of the following two links. View our CAQH profile tip sheet
  • Mental health and substance abuse clinicians need to complete the Area of Expertise form to identify their area of expertise for marketing in the Blue national directories.

If you are a Dental Practice, you may need to contact various companies for contracts. For more information view our Dental Provider Contract Clarification document.

Complete and submit the following information to enroll with a group:

Note: We are able to accept enrollment paperwork and begin the enrollment and credentialing process even if a provider is pending issuance of a State of Vermont Practitioner's license. Indicate on the Provider Enrollment/Change Form (PECF) "pending" for license # in Section 4, Provider Information.

To establish the group, you must complete and submit the following information. In addition to the below documents, a contract will be required—we will send you a contract upon receipt of your initial enrollment forms, or you can call (888) 449-0443 (option 2) to get started.

  • Group Practice Enrollment Change Online Form
  • IRS Form SS-4 notice (provides verification of EIN). The business name reported on the SS-4 notice will be the name we issue your 1099 and the name used in our online provider directory.
  • National Provider identifier (NPI)

If you are a Dental Practice, you may need to contact various companies for contracts. For more information view our Dental Provider Contract Clarification document.

For each provider associated to the group, you also need to complete and submit the following:

Note: We are able to accept enrollment paperwork and begin the enrollment and credentialing process even if a provider is pending issuance of a State of Vermont Practitioner's license. Indicate on the Provider Enrollment/Change Form (PECF) "pending" for license # in Section 4, Provider Information.

To enroll a facility, contact us directly at to providercontracting@bcbsvt.com. We will talk through the contracting and enrollment process.

For enrollment of Locum Tenen, complete and submit the below information:

Locum Tenens who will be covering for another provider for a period of 60 days or less do NOT require credentialing. 

To initiate the contracting process for durable medical equipment, complete and submit the following to providercontracting@bcbsvt.com.

  • Group Practice Enrollment Change Online Form
  • IRS Form SS-4 notice (provides verification of EIN).  The business name reported on the SS-4 notice will be the name we issue your 1099 and the name used in our online provider directory.
  • National Provider identifier (NPI)
  • Proof of liability insurance (minimum of $1m/$3m)

To begin the contracting process, email Provider Contracting at providercontracting@bcbsvt.com, as well as complete the documents noted under the Provider Enrolling with a Group section above, noting “MTM Pharmacist” in the comment note section of the form.

We use a Laboratory Benefit Manager (LBM), Avalon, for our independent laboratory network. To initiate the contracting process, please contact Avalon-providers@avalonhcs.com.

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