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Credentialing Requirements

Ancillary Facility/Supplier Business

In addition to a completed application you may be asked to submit the following, if it is applicable.

  • Signed attestation statement
  • Copy of Florida license(s)
  • Copy of Florida registration
  • Current certification of insurance (face sheet with expiration date and coverage amounts) to include errors and omissions for General and Professional liability
  • Explanations for malpractice history and disciplinary actions
  • Copy of accreditation documentation, if applicable (ASCs must be accredited)
  • If performing MR, CT, PET, NC (includes cone bean CT)- The Joint Commission, IAC or ACR accreditation is required
  • If performing mammography services, ACR Accreditation is Required
  • Copy of applicable certification(s)
  • Supervising physician statement, if applicable
  • Copy of facility medical director’s curriculum vitae, medical license, DEA certificate – if applicable
  • Copy of Medicare certification(s), if applicable
  • Copy of Medicare participation letter, if applicable
  • AHCA and/or CMS/Medicare site survey.  If not obtained, a Florida Blue site visit is required. 
5/14/2014
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.

The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

Refer to the References section to view all applicable copyrights, registered trademarks, service marks, and/or references. Acronyms are also defined in the References section.

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