Get Web Denis

Filling out the Web Denis online form is essential for providers seeking access to secured services. This guide provides clear and detailed steps to help users complete the application accurately and efficiently.

Follow the steps to successfully complete the Web Denis form.

1. Click the ‘Get Form’ button to obtain the form and open it for filling out.
2. Begin by entering the office or practice name where you are located in the designated field.
3. Specify your provider specialty to clarify the nature of your practice.
4. Fill in the street address and suite number where your practice is located.
5. Enter the city, state, and zip code in their respective fields to provide complete location information.
6. Provide the contact person's name along with their telephone number and extension to facilitate communication.
7. Indicate whether your claims are submitted electronically by selecting 'Yes' or 'No.'
8. Input the email address where you would like to receive the assigned Provider Secured Services ID.
9. Confirm your participation status with BCBSM by selecting 'Yes' or 'No' as it relates to accepting payments.
10. If you are requesting additional Provider Secured Services IDs, enter the User ID from your office that you would like to clone.
11. Determine if your office currently has access to Provider Secured Services by selecting 'Yes' or 'No.' If not, complete the required agreement.
12. For offices with existing access, provide your current Provider Secured Services ID for verification.
13. Identify the provider codes for Blue Cross Blue Shield of Michigan, Blue Care Network, and Medicare to access claim information.
14. List the provider or group name along with the lines of business and the assigned 10-digit NPI number for each provider.
15. If applicable, request e-referral access for affiliated providers by providing names and their assigned NPI numbers.
16. After completing all necessary sections, sign and date the application to authorize use and access.
17. Finally, submit the application by mailing or faxing it to the specified address or number provided in the guidelines.

Complete your documents online today for seamless access to secured services.