Blue Cross Blue Shield (BCBS) is one of the largest insurance payers. With BCBS plans being offered in all 50 states, wellness professionals and nutrition clients nationwide seek to join their network. According to their site, 1 in every 3 Americans are BCBS beneficiaries, and BCBS plans are accepted by 90% of doctors and specialists nationwide. For nutrition professionals, credentialing with BCBS can be a strategic way to grow a nutrition practice. With a steady stream of new client referrals, both from BCBS directly and other local wellness professionals, credentialing with BCBS is the right step for many nutrition practices.

With that being said, there are some nuances in the BCBS credentialing process, as well as with billing for nutrition service to be aware of. In this article, we take you step-by-step through the credentialing process and share best practices for billing Blue Cross Blue Shield as a nutrition professional.

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Credential Your Nutrition Practice with Blue Cross Blue Shield

Visit the Blue Cross Blue Shield website to submit an application to become an in-network provider. You’ll be asked to select your state, which is significant as BCBS is a nation-wide insurance payer with varying state-by-state plans. While clients are able to use their Blue Card to receive care in any state, you will always credential with your state plan and submit claims with your local BCBS office.

A comprehensive list of BCBS plans offered by state can be found here.

Pro Tip: When you enroll with BCBS you may automatically be enrolled under a BCBS Medicare Advantage Plan. This can be confusing for nutrition providers, however, you will likely be unable to receive reimbursement for any Medicare Advantage if you are not also an in-network provider with Medicare.

According to their site (although these instructions may vary according to your state, and BCBS plan) here are the steps to complete before you’ll be entered into the credentialing process.

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 portal.
2. Within CAQH, you will then need to “authorize” the BCBS company you’re credentialing with (ie. Anthem) to have access to your credentialing information. If you already have a CAQH profile, be sure to check your settings and ensure that BCBS is authorized. Failing to authorize will stall your application review. If you need assistance, please review the New Provider Quick Reference Guide or call the CAQH Provider help line at 1-888-599-1771.
3. Review and update your application. Please ensure all sections of the application are complete and accurate.

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Below is a list of the BCBS credentialing application requirements. It’s best to review this list, and to have all the information at hand to help you fill out your application quickly, and with accuracy:

• Your signature and application date
• CAQH status of “Initial Application Complete” or “Reattestation”
• Current license to practice in each state where services are provided
• Education/Training to support requested specialty(ies) (or documentation that provider will complete training within 60 days of application)
• Current Hospital Privilege information
• Current DEA or CDS certificate in each state where services are provided
• Explanations to questions on the application
• Five years’ work history, in month/year format
• Current Professional Liability Insurance
• Applicant must also allow a site review within 30 days of our request, if applicable

Depending on your state, and the BCBS plan you are becoming in-network with, the BCBS credentialing process may be subcontracted out to American Specialty Health (ASH). This would require you to contact ASH at ASHLink.com and click “Join Our Network”. You can also call them at 888-511-2743. Of the BCBS companies, Anthem typically will require nutrition professionals to go through ASH for the credentialing process. ASH will set the contracted reimbursement rate, but any benefits, eligibility checks, and claims billing will later be done directly through BCBS.

The Credentialing process typically takes 45 days from the time the Credentialing Department receives your completed CAQH application.

Checking Blue Cross Blue Shield Beneficiary Benefits

Availity is a web-based tool that provides real-time benefits information at no charge to BCBS in-network providers. Information that can be looked up about a client through Availity includes eligibility and benefits, claim status, claim submission, electronic remittance, and authorizations and referrals. The portal encompasses administrative, financial, and clinical services, supports both real-time and batch transactions and is HIPAA compliant.

Quite typically, Availity will work alongside your EHR/claims creation platform, in which you’ll verify benefits and submit claims through Availity — but you will chart and create your CMS 1500 claim through your preferred EHR provider  — unless informed otherwise by your BCBS representative. In some states, BCBS may require you to submit claims through a preferred EHR platform such as Blue-E Platform for BCBS in North Carolina). If you’re struggling to find a trusted EHR platform, consider trying out Healthie’s starter plan to test our extensive features for free.

Pro Tip: If nutrition services benefits are not visible within Availity (as this may depend on your state), there is a place within Availity to enter your nutrition procedure code – which will provide you with a number to call.

Alternatively, you can also check BCBS benefits by calling the number listed on the back of you client’s insurance card or Blue Card number (800-676-2583) to verify benefits

Creating Your CMS 1500 Claim for Blue Cross Blue Shield

As with other major insurance payers, BCBS recognizes CPT codes approved by the AMA and utilized by Medicare. The three most common medical nutrition therapy (MNT) codes that dietitians use on claims are listed below.

Public insurers, like Medicare and Medicaid, as well as private insurance carriers, can use these CPT codes.

• 97802 – For an initial assessment, face-to-face, 15 minutes per unit
• 97803 – For a follow up visit or reassessment, face-to-face, 15 minutes per unit
• 97804 – For a group visit (2 or more individuals), 30 minutes per unit

The number of units you indicate on your claim form reflects the amount of time you spend with the client, and generally up to 6 units can be covered (ie. 1 unit = 15 minutes, 6 units = 90 minutes). You will be reimbursed your contracted rate per unit billed.

What may vary per client is the diagnosis code you include. If you plan to bill for nutrition services as preventative diagnosis, here are some codes that you can verify as “covered” for your client:

• Z71.3 – Dietary counseling and surveillance
• E66.9 – obesity, unspecified
• E66.01 – morbid (severe) obesity due to excess calories

Submitting Claims to Blue Cross Blue Shield for Nutrition Services

As mentioned earlier, BCBS is a nationwide provider, but you may have clients who are beneficiaries under their Blue Cross plan in their state. If you’re seeing a BCBS commercial client, who comes in with their Blue Card, you’ll want to:

• Verify client’s benefits with their local office (call the Blue Card number)
• But submit claims to your usual/local BCBS office (and usual Payer Id number) that you have credentialed with.

Be sure to utilize the correct “Payer ID” number on your CMS 1500 claim form, as each BCBS plan has a different Payer ID number. If you have any questions about this, reach out to BCBS directly by calling their Provider Services number and request more information about where your claims need to be submitted

The image above shows how to select the correct BCBS plan and associated Payer ID number through Healthie, a practice management platform for nutrition professionals. Learn more about Healthie’s insurance billing platform and affordable plans starting at $0 here.

Receiving Reimbursement from Blue Cross Blue Shield For Nutrition Services

For easier reimbursement, you can sign up for Electronic Funds Transfer (EFT) during the credentialing process with BCBS. If you use Availity, or another clearinghouse, then your reimbursement status and details will be available to you there. If utilizing EFT, reimbursement may be available to you relatively quickly — ranging from a few days to a few weeks.