Credentialing requirements

We welcome healthcare professionals from a wide variety of specialties.

Find out what we require from physicians and other healthcare professionals.

Requirements for Blue Shield of California network providers

To join our networks, you will need to be affiliated with an Independent Practice Association (IPA) or medical group that is contracted with Blue Shield. Otherwise, you will need to sign a direct contract with Blue Shield.

Healthcare professionals who sign a direct contract with Blue Shield to join our network will be subject to credentialing by Blue Shield. Practitioners must submit a completed, signed and dated California Participating Practitioner Application, along with other supporting documents identified on the Blue Shield Credentialing Checklist included with the application.

Requirements for participation in the Blue Shield of California network include:

• If applicable, specialty board certification through a recognized U.S. specialty board, such as the American Board of Medical Specialties (ABMS), or satisfactory completion of a U.S.-based residency in your specialty or area of practice. General practitioners must have completed one year of postgraduate training and must complete two years training in the requesting specialty program.
   
• A current, unrestricted California medical license to practice, issued by the appropriate licensing board. A license status of probation may be considered restricted based on terms and conditions.
  
  
• No pending licensing issues, such as an unresolved accusation by a board issuing the applicable license to practice.
   
• If applicable, a current unrestricted Drug Enforcement Agency (DEA) registration number. Exceptions may be made for providers who do not normally obtain a DEA registration number. In those cases, the provider without a DEA registration number must provide a covering provider DEA registration number who can prescribe on their behalf.
    
• For physicians, staff privileges at a Blue Shield contracting hospital. Exceptions may be made for physicians who do not normally obtain hospital-admitting privileges. In those cases, to admit patients, the physician without admitting privileges must use an admitting panel or provide evidence that there will be another Blue Shield network physician with admitting privileges who will admit the patient.
   
• Current professional malpractice liability insurance in the minimum amounts of $1,000,000 per occurrence and $3,000,000 annual aggregate. $1,000,000 per occurrence and $2,000,000 annual aggregate for Optometrists and Audiologists. $1,000,000 per occurrence and $1,000,000 annual aggregate for Behavior Analysts.
   
• A completed professional malpractice liability questionnaire, including an explanation of all claims, settlements, and open cases.
  

Interested in joining the Blue Shield of California Promise Health Plan provider network?

Blue Shield Promise’s networks comprise more than 7,000 physicians, 80 hospitals, and hundreds of ancillary medical professionals. As a mixed-model HMO health plan, Blue Shield Promise contracts with individual physicians, and with independent physician associations (IPAs) and medical groups on a capitated basis. Under the IPA/medical group arrangements, operational functions are delegated, with Blue Shield Promise providing oversight. Our mixed model also offers an opportunity for independent physicians and other provider types to contract directly with Blue Shield Promise under flexible reimbursement methodologies.

Learn how to join Blue Shield Promise provider network

Learn about the Blue Shield Promise Medi-Cal provider orientation