Get Professional Service Secured Access Application - Bcbsm.com

Completing the Professional Service Secured Access Application online is a straightforward process designed to facilitate access to Provider Secured Services for enrolled providers. This guide will walk you through each section of the application, ensuring that you are well-prepared to submit it accurately and efficiently.

Follow the steps to complete the application online:

1. Click the ‘Get Form’ button to access the Professional Service Secured Access Application and begin filling it out in the online editor.
2. Provide your office or practice name, the provider specialty, and the street address where users are located. Ensure all entries are accurate and complete.
3. Enter the contact person's name along with their telephone number and extension. This information is crucial for communication regarding the application.
4. Fill in the city, state, and zip code of your practice. Ensure that all details are accurate to avoid potential processing delays.
5. Include the Tax ID of your office in the designated field.
6. Provide a valid email address to receive the assigned Provider Secured Services ID(s). This ensures you are notified of your application status.
7. If your office is requesting additional Provider Secured Services IDs, enter the User ID from your office that you wish to clone with the same NPI(s) in Section 2.
8. In Section 4, list the NPI numbers for new access requests and any associated provider or group names. Ensure to include Medicare Provider Codes if applicable.
9. Choose the appropriate features you are requesting access to in Section 6. Remember, each user must be included to receive an individual user ID.
10. In Section 7, ensure to provide the authorized signature, date, and title of the signatory to validate the application.
11. Review all sections for accuracy and completeness before submitting the application. Incomplete forms may cause delays.
12. Once satisfied with the entries, either save the changes, download, print, or share the form as required, and submit it to the BCBSM via mail or fax.

Start filling out the Professional Service Secured Access Application online to gain seamless access to essential provider services.