Get Ma Bcbs Mpc_120915-5w 2019

Filling out the MA BCBS MPC_120915-5W application online can streamline your contracting process with Blue Cross Blue Shield of Massachusetts. This guide will provide you with step-by-step instructions to ensure a smooth and efficient submission.

Follow the steps to complete the MA BCBS MPC_120915-5W form online.

1. Click ‘Get Form’ button to obtain the MA BCBS MPC_120915-5W application and open it in your preferred editor.
2. Begin by noting the 'practitioner information' section. Here, you will select your provider type by checking either 'Certified Nurse Midwife' or 'Certified Nurse Practitioner,' and then fill in your personal details, including first name, last name, National Provider Identifier, social security number, date of birth, and license numbers.
3. Complete the 'practice location information' section by providing the primary and any secondary practice locations, employment start date, practice name, tax ID number, and contact details.
4. Specify the billing address, indicating if it is the same as your main practice location or a different one. Include all relevant billing information, ensuring accuracy to avoid delays.
5. Fill in the 'contract recipient' section. Provide the email address of the person who will receive contractual agreements, ensuring their email is added as a trusted sender to prevent it from going to spam.
6. Indicate your availability status for accepting new patients and whether you provide telehealth services in the specified fields.
7. In the 'certification' section, check your certifying organization and ensure you attach the necessary certification documents. These must clearly show expiry dates.
8. Affirm your collaborating arrangements and provide details on any collaborating physicians, along with obtaining their information if applicable.
9. Once you have completed all sections and double-checked for accuracy, review the release and representations section, sign, and date the application.
10. Finally, save the completed form, and be sure to fax your application to the designated number. Keep a copy for your personal records.

Begin your application today and complete the necessary forms online to join the Blue Cross network.