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Get Excellus Bcbs Application For Practitioner Enrollment-c 2020-2026
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How to fill out the Excellus BCBS Application For Practitioner Enrollment-C online
Filling out the Excellus BCBS Application For Practitioner Enrollment-C online can be a straightforward process if you follow the instructions carefully. This guide will provide you with step-by-step assistance to ensure that you complete the application accurately and efficiently.
Follow the steps to complete your application with ease.
- Click 'Get Form' button to access the application form online.
- Specify your CAQH Provider ID, Taxonomy Code, and other identification numbers like your NPI and Medicaid ID. This information is critical for processing your application.
- Indicate your specialty and whether you are applying as a PCP or specialist. If applicable, select your second specialty and provide its Taxonomy Code.
- Address any disclosure questions based on your professional history, particularly those related to previous licensing or credentialing issues. If applicable, provide detailed explanations on a separate sheet.
- Gather the required documentation, including the W-9 form, proof of malpractice insurance, and any additional certification documents relevant to your specialty.
Start filling out your Excellus BCBS Application For Practitioner Enrollment-C online today!
The New York State Conference of Blue Cross and Blue Shield Plans (NYSCOP) is a partnership of New York Blue Cross Blue Shield Plans, including Excellus Blue Cross Blue Shield, Empire Blue Cross Blue Shield, Empire Blue Cross Blue Shield HealthPlus and Highmark Blue Cross Blue Shield of Western New York.
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