Credentialing

Credentialing is the process by which an organization obtains, verifies, and assesses an individual’s qualifications to provide patient care services - they need to make sure you have the licenses you say you do. 


Credentialing is free for the provider and saves the pharmacist time. Instead of sending out your work history or updating every insurance you're contract with when your license renews, a credentialing service maintains this information in a central database accessible by insurance companies. 

  • CAQH (most common)

    Start by clicking "Check for a CAQH ID" if you think there is any possible reason you would have filled this out in the past, such as working in a health system. 


    You will note as you are going through this process that the system is built for physicians, such as only schools of medicine are built into their system and schools of pharmacy will need to be typed in.


    You will need the following documents and dates:

    • Personal social security number, individual NPI, and other basic personal information (Apply for an individual NPI if you haven't already - you're usually assigned a number within 24h)
    • Pharmacy license(s) (find date first licensed using the KS board's licensing website)
    • Professional liability insurance face sheet (document showing policy number, your name, and dates eligible)
    • Pharmacy school name and address (KU is 2010 Becker Dr, Lawrence KS 66047)
    • Pharmacy school attendance dates (month/year start and end) and graduation date (likely found on your diploma)
    • (If applicable) Residency dates (month/year start and end) and completion date (likely found on your contract or certificate)
    • (If applicable) Board certification credential number and dates - initial certification date (found on certificate) as well as current credential expiration date and last recertification date
    • If applicable, any life support certifications such as CPR, BLS, ACLS, PALS, etc - last recertification date and expiration date of current credential
    • Current practice site's address, phone number, and federal tax ID/EIN

    NOTE: if your practice liability insurance is only at the store level, you will need to have your insurance provider send you a face sheet that includes your policy number and your name as a covered entity. If the face sheet does not include your name, your profile will not be approved! KPhA strongly encourages all pharmacists to have individual liability insurance (usually around $150/year).

    CAQH Registration

  • Pharmacy Profiles

    A credentialing system built for pharmacists, by pharmacists, this free profile is simple to fill out, but not commonly used by insurers.

    Pharmacy Profiles

Enrollment

Once you have credentialing proof that you are who you say you are, it's time to enroll.

Kansas Medicaid


All pharmacist-provided clinical services were moved to the new provider type on June 1, 2024 - this includes administration of all vaccines including flu shots!!! Make sure you are enrolling now to ensure you can continue to immunize your KanCare patients and keep them protected! See what's covered in these KMAP Bulletins: Pharmacists As Providers and Immunization Administration by Pharmacist Providers.

Start your KMAP Enrollment

Two steps to the KMAP enrollment:

  1. Group Application: pharmaCIES enroll as provider type ** (non-physician)/provider specialty ***. Video walkthrough of the group application
  2. Individual Within a Group: pharmaCISTS enroll as provider type 32 (non-physician)/provider specialty 276 (pharmacist). All pharmacists providing services need to enroll. Video walkthrough of the individual application


  • Currus KMAP Credentialing Guide

    Download the KMAP Credentialing Guide published by KPhA partner Currus - you will need to enter your name and email to access the document. 

  • Currus KMAP Credentialing FAQ

    • Do I need a separate Federal W-9 for each store location? 
    • No: If you have 1 TIN associated with multiple store locations, use the same current W-9 in the attachments section.
    • Yes: If any location is associated to a different TIN, you will need to upload the W-9 associated with the TIN for that location. 

    • Do I need a separate Federal W-9 for each Pharmacist? 
    • No. The W-9 that gets submitted in the IG (Pharmacist) application is associated to the Group. Follow the guidelines from question 1 on whether you’d need a separate W-9.

    • Do I need a separate Section 12 Attestation for each store location? 
    • No. The same Attestation can be uploaded for each store location. 

    • Do I need a separate Section 12 Attestation for each Pharmacist? 
    • Yes. You will need a separate attestation per pharmacist credentialed. The Section 12 Attestation is a form to allow the consent and release of the Provider’s information to the MCO’s selected. 

Contracting

Once you're credentialed and enrolled, you will need to sign a contract to agree on rates. There may also be additional training required by the insurer.


**NEW** KanCare MCO Credentialing and Contracting FAQs - click to download

Blue Cross Blue Shield of Kansas Enrollment & Contracting Information (Commercial plans)


Step 1: Fill out the Provider Network Enrollment Request (Form 15-481), found at the bottom of their provider forms page, and submit

**Use this page to help fill out the enrollment request form correctly**

This process can take anywhere from 3-12 months, so we encourage pharmacists to start on this process ASAP, even if they are not ready to initiate services!


Step 2: Contracting

**Use this page to help fill out the contract correctly**


BCBS KS Specialty Provider Representative for pharmacists - Heather Schultz
Heather.Schultz@bcbsks.com
785-291-7724

Heather will help you from start to finish - credentialing to billing. Please give Heather a call!


Video covering BCBS KS enrollment steps

BCBS KS says that pharmacists are eligible to bill anything that is in the pharmacist's scope of practice and to reach out to them if you have a question about a specific code.