Get Ma Bcbs Mpc_031918-1y-1-f 2019-2025

Filling out the MA BCBS MPC_031918-1Y-1-F form is an essential step for physician groups wishing to participate in Blue Cross networks. This guide provides clear, step-by-step instructions to help you navigate the online application process effectively.

Follow the steps to complete your application online

1. Press the ‘Get Form’ button to obtain the form and open it in the appropriate editor.
2. Complete the practice location information, including the main practice name, tax ID number, and address. Ensure all entries are accurate to avoid processing delays.
3. Fill out the section regarding practice members, indicating how new members will join your physician group contract, either by signature of each practitioner or through binding authority. If applicable, consult legal counsel for confirmation.
4. Select the Blue Cross products your group wishes to participate in. Confirm that all physicians in the group will participate in the same products, with limited exceptions.
5. Provide billing information, including the pay-to address, if different from the main practice location, and ensure that all fields are completed to prevent delays.
6. Designate a contact person and a contract recipient within your organization. This information is vital for communication regarding the application status and contract details.
7. Review the release and representations section carefully. By signing this section, you confirm that all provided information is accurate and that you are authorized to submit the application on behalf of the practice.
8. Attach a signed IRS Form W-9 to the completed application, ensuring it is properly filled out with the necessary information for reimbursement processing.
9. Once all sections are complete and accurate, save your changes, then download or print the form for your records. Finally, fax the completed and signed application to 617-246-4227.

Complete your MA BCBS MPC_031918-1Y-1-F form online today to ensure timely processing and participation in Blue Cross networks.