Get Ma Bcbs Mpc_120415-5q 2018

This guide provides clear, step-by-step instructions for filling out the MA BCBS MPC_120415-5Q contracting application online. Ensure you have all necessary information ready to complete the form accurately and efficiently.

Follow the steps to complete your application online.

1. Click the ‘Get Form’ button to obtain the form and open it in your browser.
2. Review the application requirements and ensure that you meet the credentialing criteria before proceeding.
3. Fill out the Practitioner Information section with your first name, last name, National Provider Identifier (NPI), social security number, date of birth, and any relevant state license numbers.
4. Enter your practice location information, including practice name, tax ID number, and address. Ensure you select whether this will be your primary or secondary practice.
5. If applicable, include details for any additional practice locations where you will provide services.
6. Complete the Contract Recipient section by entering the required email addresses for where to send your contractual agreements.
7. Indicate your practitioner availability status, including whether you are accepting new patients and if you offer telehealth services.
8. In the Professional Information section, select practice settings where you will render services and ensure you arrange for covering providers as required.
9. Complete the Blue Cross Product Participation and Medicare Participation section, providing necessary PTAN numbers if applicable.
10. Finalize the application by reviewing the Release and Representations section, signing as required, and noting the date of your signature.
11. After filling out the form, fax the completed application to 617-246-5053 and keep a copy for your records.

Take the next step to complete your documentation online today.