Get Bcbsm Wf 10584 Group Change Form

The Bcbsm Wf 10584 Group Change Form is essential for organizations seeking to update their provider group details effectively. This guide provides a detailed, step-by-step approach to completing the form online, ensuring a smooth experience for users of all backgrounds.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by providing the contact person's name in the designated field. This is critical for identification purposes.
3. Enter the date using the MM/DD/YY format, ensuring correctness for timely processing.
4. For individual practitioners, enter the Type 1 National Provider Identifier and the state license number as required.
5. If you are adding an individual to an existing group, include the group's Type 2 National Provider Identifier and ensure to fill out a group change form.
6. For allied providers, ensure to include the Type 2 NPI (National Provider Identifier) as well as the tax identification number.
7. For group practices, include the relevant Type 2 National Provider Identifier and tax identification number.
8. After completing all necessary sections, review the entire form for any omissions or errors.
9. Once completed, save your changes, and you may choose to download, print, or share the form as required.

Start filling out the Bcbsm Wf 10584 Group Change Form online today!