We welcome health care professionals to join our provider network and help nearly 1.5 million people in our community live healthier, more secure lives through access to high quality, affordable care.
Requirements for In-Network Providers
- Maintain a physical practice location within the Health Plan’s geographic service area
- Have accessible locations to our members which may be subject to an office site visit conducted by the Health Plan
- Providers offering telehealth services only will not be credentialed or contracted with the Health Plan
The Health Plan does not exclude from participation in its network or otherwise discriminate against providers on the basis of race, color, national origin, sex, age or disability. For more information, see our Non-Discrimination Notice.
How to apply
Step 1
Complete the application, based on your practitioner type:
- Practitioner Enrollment - CredentialedOpen a PDF
- Practitioner Enrollment - Non CredentialedOpen a PDF
- Non-Physician Health Care PractitionerOpen a PDF
- Health CoachOpen a PDF
- DentalOpen a PDF
Unsure of your practitioner type or which application to submit? Refer to our Practitioner List.
Step 2
Include all required documents along with your application. A checklist is located within the application.
Step 3
Email the application and all required documents to the following. Please note a request to participate does not guarantee that you will receive a contract.
- For Medical applications: ProviderEnrollment@excellus.comSend an Email
- For Dental applications: ExcellusDentalEnrollment@excellus.comSend an Email
Get Help
Questions about our contracting or credentialing process?
For assistance please use:
Medical: Contact Us form
Dental: Contact Us form
Update Practice Information
Help us maintain accurate provider directories and ensure members can find your practice.
Go to Update Practice Information or complete a Practitioner Demographic Change Form .
What happens next
Provider Relations will review your Enrollment Application and send the Participating Provider Agreement to review and sign. We will process your Enrollment Application uponreceipt of the signed and dated Participating Agreement. Once your enrollment is finalized, you may request a copy of the fully executed contract.
- A contract is required for all provider enrollmentsunless you are a Non-Physician Health Care Practitioner.
- You may be required to be credentialed. See Credentialing Requirements below for more information.
Credentialing Requirements
You may not provide services to Excellus BCBS members until your contract is fully executed and you are credentialed, if applicable, please reviewour Credentialing policies. Credentialing applications, included in the Enrollment Application, are processed within 60 days of receipt.
Providers can manage and update their credentialing information on the Council for Affordable Quality Health Care (CAQH)website and share with insurance carriers, including Excellus BCBS.
The applicant has the right, upon request, to be informed of the status of their application for credentialing. They also have the right to review their submitted information for credentialing and correct erroneous information, upon request. The method of communication used by the applicant will determine the method the Health Plan response(e.g.,a phone inquiry will receive a phone response, a letter inquiry will receive a letter response). The Health Plan response will includecurrent status, date of the next Credentialing Committee meeting, andidentify any missing information necessary to complete the file for presentation to the Credentialing Committee.
Application for Practitioner Enrollment (Credentialed and Non Credentialed)
To enroll a new practitioner with the Health Plan, complete the Application for Practitioner EnrollmentOpen a PDF for the following practitioner types.
To add an additional Tax ID number, complete the Practitioner Demographic Changes form .
- Acupuncturist [LAC]
- Anesthesiologist*
- Audiologist (AuD)
- Certified Diabetic Educator [CDE]*
- Certified Diabetic Educator (Independent) [CDE]
- Midwife [CNM]*
- Midwife – Home Birth (Independent) [CNM]
- Certified Registered Nurse Anesthetists [CRNA]*
- Clinical Psychologist [PhD; PsyD]
- Doctor of Chiropractic [DC]
- Doctor of Optometry [OD]
- Doctor of Podiatry [DPM]
- Emergency Medicine
- Enterostomal Therapy
- Genetic Counselor (Independent)
- Hospitalist [MD]*
- Licensed Behavioral Analyst [ABA]
- Licensed Clinical Social Worker [LCSW]
- Licensed Marriage & Family Therapist [LMFT]
- Licensed Mental Health Counselor [LMHC]
- Locum Tenens [MD]*
- MD/DO - Psychiatry only
- Medical Doctor [MD/MBBS/BMED]
- Nurse Practitioner, Primary Care
- Nurse Practitioner, Psychiatry [PMHNP]
- Occupational Therapist [OT]
- Oral Maxillofacial Surgery (DMD)
- Osteopathic Doctor [DO]
- Pathologist [MD]*
- Physical Therapist [PT]
- Radiologist
- Registered Dietician (Independent) [RD]
- Registered Dietician (affiliated with Physician Group or Hospital) [RD]*
- Speech Pathologist [SLP]
- Tele-Radiologist
*Contract and credentialing NOT required
Application for Non-Physician Health Care Practitioner
For the following practitioner types, complete the Application for Non-Physician Health Care PractitionerOpen a PDF to:
- Enroll a new Non-Physician Health Care Practitioner with the Health Plan under the supervision of physician
- Update the demographic information (Tax ID, address, etc.) for a currently enrolled non-physician health care practitioner
- Update collaborating/supervising physician for a currently enrolled non-physician health care practitioner
Non-Physician Health Care Practitioners
- Certified Behavior Analyst Assistant
- Nurse Practitioner
- Physician Assistant
- Registered Nurse First Assistant
- Licensed Master Social Worker
- Licensed Creative Arts Therapist
Application for Health Coach
Complete the Application for Health CoachOpen a PDF to:
- Add a Health Coach for Medicare and Medicaid Diabetes Prevention Program (MDPP)
- Update a Health Coach for an existing MDPP supplier
Application for Dental Enrollment
To enroll a new dental provider with the Health Plan, review the Dental Enrollment ChecklistOpen a PDF and complete the Application for Dental EnrollmentOpen a PDF.
To add an additional Tax ID number, complete the Practitioner Demographic Changes form .
Dental Practitioner Specialties for Enrollment:
- Endodontist
- General
- Oral Maxillofacial Surgery (Credentialing may be required)
- Orthodontist
- Pediatric Dentist
- Periodontist
- Prosthodontist
Enrollment Application:
- You’ll need a new contract if there’s a change to your tax ID, your individual NPI changes to a group NPI, or you are already participating and joining a new dental group.
- To follow up on enrollment status, email Dental Provider relations, ExcellusDentalEnrollment@excellus.comSend an Email
- For providers located outside of our 31 county service area, please contact DenteMax.
Join our Network - Styles/Script
Code to show medical or dental class (dental-par or dental-nonpar) according to Provider role
