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  • Authorization Form - Blue Cross And Blue Shield Of Alabama - Bcbsal

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Illed out. PATIENT INFORMATION Patient Name Contract Number Patient Date of Birth Patient Phone ( ) PRESCRIBER INFORMATION Physician Name Physician NPI Provider # - Office Phone ( ) Office Fax ( ) Address.

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How to File a Claim Call Preferred Long-Term Care (LTC) Customer Service (1-888-331-4188) to complete the Claims Intake Form over the telephone. Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us.

About Blue Cross and Blue Shield of Alabama Connect with us on Facebook, check out our videos on YouTube and follow us on Twitter for more up-to-date information. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association.

Provider Enrollment/Credentialing Call the IVR: 205-220-6765. Fax (provider credentialing applications and related documents): 205-220-9545.

Precertification is required for many services, including the following outpatient hospital benefits, physician benefits and other covered services.

How to File a Claim Call Preferred Long-Term Care (LTC) Customer Service (1-888-331-4188) to complete the Claims Intake Form over the telephone. Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us.

This should be completed by vendors, billing services and clearinghouses for each new payee wishing to receive electronic remittance files. Existing Vendors, please fax completed forms to 205-733-7362, Attention: Enrollment, or email to EDIEnrollment@bcbsal.org.

Call 1-855-880-6350 7 a.m. - 6 p.m. Central Time, Monday through Friday. Email Customer Service.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232