Joining our network is easy!
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)
Credentialing with Healthy Blue
Why do we credential?
Credentials are evaluated according to criteria set forth in our policy to ensure the competency and conduct of the healthcare professionals serving members in our network.
Who do we credential?
We credential licensed healthcare professionals with whom the company intends to contract and market to our members. Our Program Summary includes a complete list of provider types we credential and those we do not.
Please note: Facilities (health delivery organizations) may also need to be credentialed before joining the network.
1. Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org. This is a secure and private website.
2. Authorize Healthy Blue so we can access your credentialing information. If you are already registered with CAQH, you will need to give us permission to review your information.
3. If you need assistance, please review the Provider Reference Guide or call the CAQH Provider help line at 888-599-1771.
4. Review and update your application. Please ensure all sections of the application are complete and accurate.
Credentialing application requirements
The credentialing process typically takes 45 days from the time the credentialing department receives your completed CAQH application.
Healthy Blue recredentials network providers every three years. If your CAQH application is current and complete at that time, no additional effort on your part may be required. If your CAQH has expired or has missing information, we will contact you to update the information.
Non-response to recredentialing request
If you do not update CAQH or supply the required information for recredentialing by the due date, your application will be considered incomplete and will result in an administrative termination from the network.
Providers have the right to:
- Review information submitted to support their credentialing application.
- Correct erroneous information.
- Receive the status of their credentialing or recredentialing application upon request.
For a complete list of your credentialing rights as a provider, please review the Practitioner Credentialing Rights. To review your application or correct submitted information, please email our credentialing team at: credentialing@healthybluemo.com.
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 Blue View Vision .
Behavioral health providers
New behavioral health practitioners/groups that are not multispecialty and existing groups that have been notified of their contract assignment to Carelon Behavioral Health, Inc.* should enroll with Carelon Behavioral Health, Inc. (formerly Beacon Health Options) at Carelon Behavioral Health .
* CAQH Proview® is an independent company proving online provider data-collection solution services on behalf of Healthy Blue.
* Carelon Behavioral Health, Inc. is an independent company providing utilization management services on behalf of the health plan.
Provider Tools & Resources
- 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