Blue Cross Blue Shield

How to Get Credentialed with Highmark Blue Cross Blue Shield West Virginia in West Virginia

Network: Open
45-90 Days CAQH Required

Quick Overview

Timeline

45 - 90 days

CAQH

Required

Re-credentialing

Every 3 year(s)

Delegated

No

West Virginia-Specific Requirements

Highmark Blue Cross Blue Shield West Virginia (Highmark Inc. subsidiary). Uses CAQH ProView alongside the Highmark provider portal for credentialing. Typical processing timeline: 60-90 days. Requires active West Virginia medical license from the West Virginia Board of Medicine or the West Virginia Board of Osteopathic Medicine. DEA registration and West Virginia controlled substance license required. Board certification required for specialists. Highmark operates across PA, WV, and DE — multi-state credentialing may be available for providers practicing in multiple Highmark states. Delegated credentialing available through select health systems. Re-credentialing every 3 years.

Step-by-Step Enrollment Process

1

Gather Required Documents

Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for West Virginia.

2

Complete Your CAQH ProView Profile

Highmark Blue Cross Blue Shield West Virginia requires a current CAQH ProView profile. Create or update your profile at proview.caqh.org and attest within 120 days.

3

Submit Your Application

Submit your completed enrollment package to Highmark Blue Cross Blue Shield West Virginia.

4

Track & Follow Up

Credentialing typically takes 45-90 days. Monitor your application status and respond promptly to requests for additional information.

Free Consultation

Need help enrolling with Highmark Blue Cross Blue Shield West Virginia?

Our specialists handle the entire Highmark Blue Cross Blue Shield West Virginia enrollment process: applications, follow-ups, and approvals in West Virginia.

Required Documents Checklist

Board Certification

Conditional

Required if board certified; highly recommended

CV/Resume

5-year work history minimum; gaps > 6 months must be explained

DEA License

Conditional

Required if prescribing controlled substances

Malpractice Insurance

Medical Degree

Medical License

NPI Certificate

Professional Reference

3 peer references required

Enrollment Forms

CAQH ProView

Universal credentialing application used by most commercial and BCBS payers.

Required
Online Open →

Key Credentialing Terms

CAQH
The Council for Affordable Quality Health Care, an organization that maintains a universal provider database (CAQH ProVi...
Credentialing
The process of verifying a healthcare provider's qualifications, training, licensure, and professional background to ens...
Effective Date
The date on which a provider's enrollment or network participation becomes active, allowing them to begin billing a paye...
Fee Schedule
A complete listing of fees and reimbursement rates that an insurance payer will pay for specific medical services and pr...
HMO
A Health Maintenance Organization is a managed care plan that typically requires members to choose a primary care physic...
Network Status
A provider's participation status with a specific insurance payer, indicating whether they are in-network (contracted) o...
NPI
The National Provider Identifier is a unique 10-digit identification number issued by CMS to healthcare providers, requi...
PPO
A Preferred Provider Organization is a managed care plan that offers a network of contracted providers at lower costs to...

Credentialing Checklist

Make sure you have everything ready before applying to Highmark Blue Cross Blue Shield West Virginia.

View Physician Credentialing Checklist →

Contact Information

Provider Credentialing

National

888-599-1771

Mon-Fri 8am-5pm

Provider Services

National

888-599-1771

Claims & Billing

National

888-599-1771

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Reviewed by the PayerReady Credentialing Team

Our credentialing specialists verify every article against current CMS regulations, NCQA standards, and payer-specific enrollment requirements. See our editorial process.

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