We’re glad to hear that you are interested in joining the Healthy Blue network. We have a diverse network of exceptional health care professionals who ensure our members have uninterrupted access to the health care they need.
Join Healthy Blue - The process
Participation in our networks is based on member access and need. The process for joining our network may include contracting, credentialing, and enrollment. The online provider enrollment application will route your request to all the needed steps:
- Contracting/negotiating: The process of the provider and Healthy Blue formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc
- Credentialing: The process of reviewing the qualifications and appropriateness of a provider to join the health plan's network. Credentialing requirements and processes will follow National Committee for Quality Assurance (NCQA) guidelines and company credentialing policy
- Loading: The process of loading a contracted and credentialed provider to all Healthy Blue internal systems, loading for claims payment, and loading to the provider directory (if applicable)
Ready to join — Next steps
To become a contracted provider or add a provider to your existing group:
- Update your CAQH Proview®, ensure that your:
- Primary specialty is listed
- Primary location is listed
- Attestation is current
- Ensure that you have an active Missouri Medicaid identification number. For more information on provider enrollment, please visit the Missouri Department of Social Services.
- Complete the online provider enrollment application hosted on the Availity portal*. The online application automatically accesses CAQH Proview®. To learn more about or register for the Availity portal please visit our Learn About Availity page .
- Notification — you will be notified if:
- A new contract is needed
- Your specialty is not needed/allowed
- Any further credentialing information is required
- Status updates: You will receive an application number upon successful completion of the provider enrollment application to assist with tracking your progress.
- Remember to obtain an approved prior authorization before seeing Healthy Blue members until you are participating.
- Keep in mind, to be considered participating, you/your provider must be loaded. The process usually takes between 60 and 90 days.
Facilities, ancillary, and health system providers
To Join Healthy Blue, please send an email and W9.
Dental providers
Healthy Blue will contract for medical procedures, but routine dental benefits are managed by Dentaquest.
Vision providers
Healthy Blue will contract for medical procedures, but routine vision benefits are managed by March Vision.
* CAQH Proview® is an independent company proving online provider data-collection solution services on behalf of Healthy Blue.
Provider Tools & Resources
- Roster Automation Standard Template
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Eligibility Overview
- Provider Manual and Guides
- Provider Search Tool
- Forms
- Training Academy
- Electronic Data Interchange (EDI)
- Quality of Care Incident Form