Get Provider Notification Form - Blue Cross Blue Shield Of Oklahoma - Bcbsok

Filling out the Provider Notification Form for Blue Cross Blue Shield of Oklahoma can seem daunting, but this guide will walk you through each section methodically. Whether you are adding a new provider, updating existing information, or closing a location, this step-by-step approach will ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the Provider Notification Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing application.
2. Begin by entering your provider name in the designated field. Ensure that the information is spelled correctly as it appears on your credentials.
3. Input your degree in the appropriate section to reflect your qualifications.
4. In the 'Action Requested' column, clearly indicate whether you are adding, updating, or closing a location.
5. Enter the effective date of the changes in the following format: MM/DD/YYYY.
6. Provide your rendering NPI in the respective field to confirm your identity as a provider.
7. Fill out your office hours for each day of the week, noting the opening and closing times clearly.
8. Include your state license number and tax identification number in the required fields.
9. List the name of the office contact and their email to facilitate communication regarding your submission.
10. If applicable, provide the supervising physician's name for nurse practitioners or physician assistants.
11. Fill in the credentialing contact details, including name, phone number, and email for any follow-up.
12. Indicate if you are board certified by marking 'Yes' or 'No'. If 'No', provide the date of graduation or residency completion.
13. Supply your CAQH number if you have one, and detail the service location type, such as an office or hospital.
14. Complete the physical address fields, ensuring accuracy with city, state, and zip code.
15. Provide names and emails of the communication contacts for newsletters and notifications.
16. Fill out the group name and NPI if you are part of a group practice.
17. Add the network/contracting contact information, including name, telephone line, and email.
18. Optionally, include your social security number and date of birth for CAQH profile matching purposes.
19. Sign the form, as a physical signature is not required if submitted via email.
20. After completing all sections, review the form for accuracy and save your changes. You may download, print, or share the form as needed.

Complete your Provider Notification Form online today to ensure timely processing.