Get Network Interest Form - Blue Cross And Blue Shield Of Alabama - Bcbsal

This guide offers a comprehensive overview on properly completing the Network Interest Form for Blue Cross and Blue Shield of Alabama. Whether you are a new applicant or an existing provider expanding your network, this step-by-step approach will help you navigate the form with ease.

Follow the steps to accurately complete the Network Interest Form.

1. Press the ‘Get Form’ button to access the document and open it within your preferred document editor.
2. Begin by filling out the provider's name in the designated field. Ensure the name is accurate and reflects how you are known professionally.
3. Input your Individual NPI (National Provider Identifier) to identify your professional credentials. If applicable, also enter your Organizational NPI for institutional submissions.
4. Provide the practice name under which you operate. This should be the official name used in your practice.
5. Enter your Tax ID number accurately for tax purposes and identification.
6. Fill in your email address for communication regarding the application status and any further instructions.
7. Include your office phone number and, if applicable, your fax number to facilitate contact.
8. Complete the office address with the street, city, state, zip, and county to ensure proper identification of your practice location.
9. If your mailing address differs, fill it out by including the relevant city, state, zip, and county.
10. Review the Provider Attestation section. Read the terms carefully and, upon agreement, sign and date the form to validate your submission.
11. After verifying that all information is complete and accurate, you have options for submission: Save the form, print it, or share it as needed.

Complete and submit your application for network inclusion online to start your journey with BCBSAL.