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Speed Guides
Tidbits
Workshop and Webinar Presentations
Past Workshops
2023 Professional Workshop
Recent Webinars
2024 BlueCard Webinar
2023 Sleep Management Program Webinar
2023 New to Blue Webinar - Professional
2023 New to Blue Webinar - Facility
2023 Provider Credentialing and Data Management
2023 Behavioral Health – Facility
2023 Behavioral Health – Professional
2022 New Security Setup Application Webinar
2022 Laboratory Benefit Management Program
2019 CES Webinar - Professional
Forms
Admissions and Recertifications Form
Alternative Dental Procedure Payment Responsibility Form
Authorization Form
Behavioral Health Provider Clinical Profile Form
Blue Cross CAA Consent Submission Form
Consumer's Right to Know Facility Reporting Form
Continuity of Care Request Form
Coordination of Benefits Questionnaire
Electronic Funds Transfer Application
Electronic Remittance Advice (ERA) Enrollment Form
Itemized Bill Cover Sheet
No Surprises Act Open Negotiation Notice
OGB Bariatric Surgery Form
Overpayment Notification Form
Professional Liability Information Form
Provider Disputes Form
Rainmaker Application Form
Reimbursement During Credentialing
Release of Protected Health Information Form
Retrospective Review Authorization Form
Utilization Management Approval and Denial Fax Form
The documents below are available in DocuSign® format only. As of March 17, the PDF versions of these forms are no longer available. Submitting these forms in the DocuSign format allows the Provider Credentialing & Data Management staff to continue processing your requests as our employees take precautionary measures to prevent the spread of the novel Coronavirus (COVID-19). For details on completing DocuSign forms, view this guide. When submitting DocuSign documents, please do not separately email them to Blue Cross. We automatically receive your submission from the DocuSign application. Double submissions (submitting through DocuSign and also sending an email of the completed form) could delay the processing time for your request.
Your request can take up to 90 days to process once all required information has been received. Providers will remain non-participating in our networks until their credentialing application has been approved by the credentialing committee and an executed contract is in place.
DocuSign Format
iLinkBlue Agreement Packet
Professional Initial Credentialing Packet
(now includes LCSA Attachment A)
Facility Credentialing Packet
(now includes all HDO Attachments)
New/Revised Medical Policies
Effective Feb. 1, 2024
Revised Policy No. 00034: Treatment of Varicose Veins/Venous Insufficiency
Effective March 1, 2024
Revised Policy No. 00233 – Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment and Immunotherapy in Metastatic Colorectal Cancer
Effective April 1, 2024
Revised Policy No. 00656 – Next-Generation Sequencing for the Assessment of Measurable Residual Disease
New/Revised Lab Reimbursement Policies
New Policies
Effective for dates of service on and after March 1, 2024:
Revised Policies
Effective for dates of service on and after Nov. 1, 2023
