Credentialing by payer
Join the Capital Blue Cross Network
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
- Flat PricesNo percentage of collections
- Half Now, Half at SubmissionFor every enrollment application
- Closed Network?Your choice of a refund or a credit
- Live Status TrackingCheck any application by reference number
Capital Blue Cross at a Glance
| Service area | 21 counties in central Pennsylvania and the Lehigh Valley: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York. |
|---|---|
| How to request to join | Download the forms for your practice type (provider data form, eSOR enrollment form, W-9, Authorization for Third-Party Attestation, EFT form, plus an Areas of expertise form for behavioral health) and email them to CBC.CAICRecruiters@capbluecross.com or fax them to 717.526.3037. Start here |
| Portal | Availity Essentials. Contracted providers must enroll in EFT, Availity and electronic remittances within 90 days of the contract date. |
| CAQH ProView (DataSpring) | Yes, exclusively. All providers use CAQH ProView (DataSpring) for credentialing and recredentialing, and must authorize Capital Blue Cross or grant global authorization. A lapsed attestation can end participation. |
| Behavioral health | Behavioral health clinicians use the same front door with the behavioral health form set, which adds the Areas of expertise form. |
| Published turnaround | Capital notifies providers of credentialing decisions within 60 days of committee review. The file must be dated within 120 days of the committee decision, so a long process can mean updated CAQH data and re-verification. |
| Recredentialing | At least every three years. |
| Lines of business | Traditional, PPO, POS, Keystone Health Plan Central and Medicare Advantage HMO networks. |
How Capital Blue Cross Takes Applications
Capital emails contracting information after it receives your forms, and a contract is required for every network. Credentialing runs from the CAQH profile. Wait for the second written notice that gives your participation effective date before scheduling Capital members.
What to Watch With Capital Blue Cross
Claims before the effective date are processed out-of-network and paid to the member. Facility, home health, hospice and skilled nursing networks are closed to new providers of those types. Dentists apply through Dominion National instead.
Whatever the plan, the file moves only when your CAQH (DataSpring) profile, license record and application agree. See how long credentialing takes and our CAQH profile setup service.
Questions About Capital Blue Cross
How do I apply to Capital Blue Cross?
Download the forms for your practice type (provider data form, eSOR enrollment form, W-9, Authorization for Third-Party Attestation, EFT form, plus an Areas of expertise form for behavioral health) and email them to CBC.CAICRecruiters@capbluecross.com or fax them to 717.526.3037.
How long does Capital Blue Cross credentialing take?
Capital notifies providers of credentialing decisions within 60 days of committee review. The file must be dated within 120 days of the committee decision, so a long process can mean updated CAQH data and re-verification. Recredentialing: At least every three years.
Does Capital Blue Cross use CAQH (DataSpring)?
Yes, exclusively. All providers use CAQH ProView (DataSpring) for credentialing and recredentialing, and must authorize Capital Blue Cross or grant global authorization. A lapsed attestation can end participation.
How do therapists join Capital Blue Cross?
Behavioral health clinicians use the same front door with the behavioral health form set, which adds the Areas of expertise form.
What does PECS charge for a Capital Blue Cross application?
$200 per application per provider, half at engagement and half at submission, including follow-up with Capital Blue Cross until the effective date is set.
Want Capital Blue Cross handled? Get your self-serve quote.
Get an instant answer, or send it to our team and we will reply by email within one business day.
Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
Sources
Facts checked against the sources above in October 2026; plan procedures change.