Provider Credentialing Process


How Do Providers Become Part of Our Network?
Thank you for your interest in becoming a participating provider with BlueShield of Northeastern New York.  We value your business and strive to provide quality service to our Providers and Members.
Initial Credentialing
Providers can enroll into our health plan by filling out the Universal Credentialing Application with CAQH, the Council for Affordable Quality Healthcare.
UPD Quick Reference Guide

How it Works:
Follow this link to access the Universal Provider DataSource


  • Under Providers, click: 'Go to the Universal Provider Datasource' and login.
  • Enter your CAQH Provider ID (if you don't know it, call CAQH at 1-888-599-1771).
  • Enter or update your information.
  • Authorize BlueShield of Northeastern New York to access your information electronically.
  • If you do not have a CAQH application, follow the link below to download a CAQH roster form.

Complete form below and return to the fax number provided.
New Provider Enrollment & Disclosure of Ownership Control


Nurse Practitioner/Certified Nurse Midwife Collaborating Physician Agreement

Physician Assistant/CRNA/RFNA Supervising Physician Form



The CAQH Universal Credentialing Application is our data source for recredentialing.  As such, it is important that you keep your information on CAQH current. Update your CAQH application regularly with license(s), malpractice, demographic information, disclosure questions and attest to the accuracy of the information in the application.


Done with your credentialing application?
Ready to start the contracting process?

Give us a call at one of the following numbers:
1-716-887-2054 OR 1-800-666-4627