Get Ok Bcbs Group/clinic Provider Enrollment Form 2020-2025

Filling out the OK BCBS Group/Clinic Provider Enrollment Form online is an essential step for providers looking to join the Blue Cross and Blue Shield network. This guide will provide you with clear, step-by-step instructions to help you navigate and complete the form efficiently.

Follow the steps to complete the enrollment form accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor for filling out.
2. Start by entering your submitter information, including your first name, middle initial, last name, email address, suffix, telephone number, job title or position, and select your network participation status as either in-network or out-of-network.
3. Next, provide your group practice information. Fill in the group practice name, start date, Type 2 NPI (if applicable), tax identification number (TIN), and group website URL.
4. Move on to additional group practitioner information. Indicate the primary group type, primary group specialty, and any additional group type as required.
5. Enter your office physical location details, including location name, office contact name, telephone number, fax number, and the address (line 1, line 2, city, state, and zip code). Specify whether this is the primary location and if the location is accepting new patients.
6. Complete the hours of operation section by selecting the time zone and providing opening and closing times for each day of the week.
7. Respond to the Americans with Disabilities Act (ADA) compliance questions to assure accessibility standards are met for various facilities within your practice.
8. In the treating categories section, check any applicable services that your practice provides, ensuring at least one category is marked.
9. Fill out the associations section if applicable, providing necessary names and tax IDs.
10. Provide correspondence, billing, and credentialing addresses, indicating if they are the same as your office physical location. Include contact information for each address.
11. Complete the administrative contact section, including the name, job title, telephone number, fax number, and email address.
12. Answer the practice information questions, indicating whether you render telemedicine and laboratory services, as well as lactation services.
13. Fill out the medication-assisted treatment (MAT) section accurately if applicable.
14. Complete the questionnaire regarding past participation in BCBS and attach any required documentation as indicated in the attachments section.
15. Conclude by filling out the attestation section, providing your authorized name, title, tax identification number, and the date.
16. Once all sections are complete, review your entries for accuracy, then save changes, download, print, or share the completed form as needed.

Begin filling out your OK BCBS Group/Clinic Provider Enrollment Form online today and ensure all information is complete to facilitate your enrollment process.