Effective March 26, 2019, BCBSRI implemented new credentialing requirements for nurse practitioners (NPs) who are also licensed primary care providers (PCPs). NPs may be credentialed by BCBSRI as a PCP with or without a panel.

A NP/PCP without a panel must be licensed by the Rhode Island Department of Health (RIDOH) as a clinical nurse practitioner (CNP) or clinical nurse specialist (CNS) in one of the following specialties:

• Family/individual across the lifespan
• Pediatric
• Adult/gerontology

A NP/PCP with a panel must be licensed by RIDOH as a CNP or CNS in one of the following specialties:

• Family/individual across the lifespan
• Pediatric
• Adult/gerontology

Additionally, a NP/PCP with a panel must either have:

• Six months of experience working in their area of focus and be a member of a patient-centered medical home (PCMH) or a system of care (SOC) that is recognized by BCBSRI or a Federally Qualified Health Center (FQHC).
• OR have three years of experience working in a primary care practice.

All new NP/PCP applicants and status change requests will be reviewed by the Credentialing Committee.

If you have any questions regarding the new change, please contact ProviderRelations@bcbsri.org.