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  • Blue Cross Rhode Island Practitioner Change Form Fillable

Get Blue Cross Rhode Island Practitioner Change Form Fillable

Print Form Practitioner Change Form DIRECTIONS: Please check all that apply and fill in sections as directed. q Tax ID Change Complete Sections 1 and 2. Attach a completed W-9 form. q Change in Practice.

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Contact support

If you have questions about whether or not your claims meet all conditions of a “clean claim,” you may contact the Physician and Provider Service Center at (401)-274-4848 or 1-800-230-9050. 1.

In the ANSI file, the Carrier Reference (Payer ID) for BCBSRI must be 00870 for Blue Shield/ Blue Chip and 00370 for Blue Cross/Blue Chip. Any other Payer id will not be recognized by our system.

To file a claim: Complete a CMS-1500 claim form. Submit the form to: Blue Cross & Blue Shield of Rhode Island. ATTN: Claims Department. 500 Exchange Street. Providence, RI 02903.

In the ANSI file, the Carrier Reference (Payer ID) for BCBSRI must be 00870 for Blue Shield/ Blue Chip and 00370 for Blue Cross/Blue Chip.

If you are a provider unable to access the MHK portal, please complete this form and fax to 401-459-2503. BCBSRI's BH staff will be in touch with you within 3 business days to provide your authorization number needed for claims processing.

Are you looking for something specific? Monday through Friday 8:00 a.m. to 4:30 p.m. Please contact your account executive or call our main number at (401) 459-1000 or 1-800-637-3718 outside Rhode Island.

If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at .evicore.com. Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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