Get Bcbs Fee Schedule Request Form

Filling out the Bcbs Fee Schedule Request Form online can be a straightforward process when you have clear guidance. This form is essential for requesting the fee schedule and specific procedure codes from Blue Cross and Blue Shield of Illinois.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and access it to fill out the necessary fields.
2. In the relevant section, provide the information about your request. Indicate whether you are requesting the Fee Schedule or the National Drug Codes by selecting the appropriate checkbox.
3. Fill in your provider name where indicated. This information should accurately reflect the name associated with your practice or organization.
4. Enter your Billing NPI Number, which is crucial for identification in the application process.
5. Complete your address by filling in the city, state, zip code, and county fields. Ensuring this information is correct is important for correspondence purposes.
6. Provide your telephone number and fax number. This will facilitate communication if any further information is needed.
7. Input your email address in the designated field, making sure it can receive emails from specified addresses. Choose your preferred method of receiving the Fee Schedule by selecting either 'Copy of Fee Schedule on CD (Microsoft Excel spreadsheet)' or 'Email Fee Schedule (Microsoft Excel spreadsheet)'.
8. Sign and date the form to confirm the accuracy of the information provided.
9. Review the confidentiality agreement section carefully, sign where required, ensuring all necessary parties are represented.
10. Once all fields are completed, save your changes. Download, print, or share the form as needed to facilitate submission.

Start filling out your Bcbs Fee Schedule Request Form online today!