To 617-246-4227 Blue Cross* will evaluate this application according to your ability to meet pre-established credentialing criteria and network need, as determined solely by Blue Cross. We reserve the unqualified right to reject any and all applications, subject to the terms of this application and applicable law. By accepting this application for evaluation, we agree that any patient-specific or identifying information, any non-publicly available information that you designate as confidential s.
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How to fill out the MA BCBS MPC_120915-2A online
Filling out the MA BCBS MPC_120915-2A form online is a crucial step in the contracting process with Blue Cross Blue Shield of Massachusetts. This guide provides detailed instructions to help you navigate each section of the form efficiently.
Follow the steps to complete your form accurately.
- Press the ‘Get Form’ button to access the MA BCBS MPC_120915-2A form and open it in your preferred editing tool.
- Begin by providing your practitioner information. Fill in fields such as your first name, last name, National Provider Identifier (NPI), social security number, date of birth, Massachusetts license number, and DEA certificate number if applicable.
- Enter your practice location information. Specify your main practice location, including the legal name of your practice, tax ID number, and address. It is essential to ensure that all details are correct to avoid delays.
- If applicable, fill in information for any additional practice locations where you will be providing services. Include the site name, street address, and phone number for scheduling appointments.
- Complete the billing address section, indicating whether it is the same as your main practice location or entering a different address.
- Provide the necessary details for contract recipient and welcome letter recipient, which includes the email addresses of the designated individuals. Ensure you add BlueCrossContractOps@bcbsma.com as a trusted sender.
- Indicate your practitioner availability status and the services you offer, such as accepting new patients or providing telehealth services.
- Continue filling out the collaborating/supervising arrangement section by listing your collaborating physician's details. This is necessary for compliance with contract requirements.
- Complete the sections related to hospital affiliation and admitting privileges if applicable to your practice.
- Select the Blue Cross products you wish to participate in and read through the signature waiver section, making your choice accordingly.
- Review and sign the release and representations section, ensuring all information provided is accurate.
- Once completed and signed, save your changes, and consider downloading or printing a copy of the form for your records. Finally, fax the completed application to 617-246-4227.
Complete your MA BCBS MPC_120915-2A form online today to ensure a smooth application process.
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Is Blue Cross Blue Shield of Massachusetts private insurance?
Blue Cross Blue Shield of Massachusetts (BCBSMA) is a state licensed nonprofit private health insurance company under the Blue Cross Blue Shield Association with headquarters in Boston.
Does Blue Cross Blue Shield work in Massachusetts?
Blue Cross Blue Shield of Massachusetts serves nearly three million members. For more than 80 years, our company has worked hard to achieve our mission providing access to high-quality, affordable health care for the individuals, families, and businesses we serve.
How do I contact Blue Cross Blue Shield Massachusetts?
1-800-262-2583.
What is the payer ID for Blue Benefit Administrators of Massachusetts?
Filing claims Use payor ID 03036 to submit claims electronically. Call your clearinghouse or Change Healthcare at 1-800-266-2206 for help submitting claims.
How do I submit a claim to BCBS Texas?
Availity provides administrative services to BCBSTX....How to access and use Availity's Claim Submission tool: Log in to Availity. Select Claims & Payments from the navigation menu. Select Professional Claim or Facility Claim. Within the tool, select your Organization, Transaction Type and Payer. Complete the required fields.
What is the address for BCBS of Massachusetts claims?
Mailing Address (claims and correspondence): Blue Benefit Administrators of Massachusetts. PO BOX 55917. Boston, MA 02205-5917.
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