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  • Ok Bcbs Solo Provider Enrollment Form 2020

Get Ok Bcbs Solo Provider Enrollment Form 2020-2025

Attn: Network Management Department P.O. Box 3283 Tulsa, OK 74102-3283 PLEASE COMPLETE ALL INFORMATION WITHIN. THIS PACKET WILL BE RETURNED IF INCOMPLETE. SUBMITTER INFORMATION FIRST NAME MIDDLE INITIAL EMAIL ADDRESS LAST NAME SUFFIX TELEPHONE NUMBER JOB TITLE/ POSITION NETWORK PARTICIPATION (SELECT ONE) PARTICIPATE IN-NETWORK PARTICIPATE OUT-OF-NETWORK COMPLETING THE FORM FOR CONTRACT AS SOLO PROVIDER PRACTITIONER INFORMATION IS THE PROVIDER CURRENTLY IN A RESIDENCY.

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Calle us at 1-866-288-3539 (TTY 711). We're open between 8 a.m. – 8 p.m., local time, 7 days a week.

Note: Customer Service: (918) 560-3500.

You are a new group/provider with a Level 2-Organization NPI....Required for all Providers: Current Oklahoma State Healthcare License - Provider Must be Located and/or Performing Services in the State of Oklahoma. Malpractice Liability Insurance. Provider Disclosure of Ownership and Control Interest Form. Valid W-9.

BCBSOK has received updated guidance to apply the contracted timely filing (typically 180 days) plus one year.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232