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  • Network Advantage Provider Application Form

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Year: Expiration: Date of Issue: Expiration Date: CEAP Certificate #: Are you a Certified Employee Assistance Professional (CEAP)? Y N ADDITIONAL CERTIFICATIONS (Including but not limited to CISD, coaching, training, etc. Please include a copy of your certificate.) Certification Type: Certification #: Date of Issue: Expiration Date: Certification Type: Certification #: Date of Issue: Expiration Date: Certification Type: Certification #: Date of.

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During the credentialing or recredentialing process, you can ask questions about the status of your application, ask to review information submitted to support your application and correct anything in error by calling us at 1-800-822-2761.

Please follow the steps below: Step 1 - Required Documents for All Providers/Specialties. There are several required documents that you must submit for enrollment. ... Step 2 - National Provider Identifier (NPI) - Required. ... Step 3 - Provider Enrollment Application/Supporting Documents. ... Step 4 - Express Your Network Interest.

How do I register? Once you've registered for the portal and received your user ID and password, or if you already have a user ID and password, log in. Once you've logged in, select "Register Provider(s)" under the Electronic Funds Transfer section. Complete the required information and submit the form.

Blue Advantage (PPO) Information. Please select Blue Advantage (PPO) below to review the information about the Blue Advantage (PPO) plan. This plan is strictly for Medicare Advantage members of BCBSAL.

Provider Enrollment/Credentialing To request a provider application, check application status, add a new location or update provider information, please use one of the following methods: Access Enrollment and Credentialing online. Email Credentialing. Call the IVR: 205-220-6765.

Blue Cross and Blue Shield of Alabama has insured Alabamians for over 82 years. Blue Cross offers coverage plans to corporations, individuals and the senior market. For more information about Blue Cross, visit AlabamaBlue.com.

Providers who want to contract with Blue Cross NC Once you have become credentialed and enrolled with your registered NPI number and tax ID, you can begin the contracting process. To begin the process, call 800-777-1643 (option 6). Please allow at least 60 days for Blue Cross NC to process your application.

Payer Name: Blue Cross Blue Shield of Alabama|Payer ID: 510|Professional (CMS1500)/Institutional (UB04)[Hospitals]

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232