Get Therapy Network Application - Bcbsal.org - Blue Cross And ... - Providers Bcbsal

Completing the Therapy Network Application is an essential step for providers seeking to participate in Blue Cross and Blue Shield programs. This guide will walk you through the online application process, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred online editor.
2. Begin with the general information section. Input the provider’s last name, first name, middle name, and suffix as applicable. Ensure that you include the National Provider Identifier (NPI), Social Security Number, and date of birth. Provide details of your birth county and citizenship status, along with your professional title and preferred name.
3. In the medical education section, list the dates attended for your education. Include the name of the school, degree awarded, and address details.
4. Complete the postgraduate education training section similarly to the education section. Provide all pertinent dates and institution details.
5. In the license information section, specify the state of licensing and include the license number, licensing board, and important dates such as when you were originally licensed and when your license expires.
6. For the financial information section, indicate if you have any financial interests in other healthcare entities and provide details if applicable. Specify if you are using a billing agency, the name of the agency, and submit any required contracts.
7. Fill out the practice location information accurately. Indicate if you have multiple locations, and for each location, provide the name, address, and contact information. Also, inform whether you are accepting new patients.
8. Answer the malpractice information section honestly. Provide details of your current professional liability carrier and the duration of coverage.
9. Complete the section on other practice affiliations and professional memberships. Include the names and contact details of affiliations as required.
10. For the question & answer section, respond to each query truthfully, especially regarding any legal or disciplinary actions against you.
11. Fill in the contact information for someone who can provide additional details if needed. This should include their name, email, and telephone number.
12. Review the provider certification section carefully. Ensure that all provided information is accurate; it's essential to certify that you understand compliance obligations.
13. Finally, save your completed application. Use options to download or print the form, and submit it via fax or mail as directed at the end of the application.

Complete your Therapy Network Application online today and ensure your participation in essential health programs.