Get Ok Bcbs Group/clinic Provider Enrollment Form 2020-2025

Filling out the OK BCBS Group/Clinic Provider Enrollment Form online is an essential step for health care providers to join the Blue Cross Blue Shield network. This guide provides a detailed, step-by-step approach to help you complete the form accurately and efficiently.

Follow the steps to complete the enrollment form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling out the submitter information section. Ensure that all required fields are completed, including first name, last name, telephone number, and job title.
3. Provide details about your group practice, including the group practice name, start date, Type 2 NPI, and Tax Identification Number.
4. In the additional group practitioner information section, indicate the primary group type and specialty, as well as any additional group types.
5. Enter the office physical location details. Fill in all mandatory fields, such as location name, contact name, and address information. Specify if the location offers language services and if it is the primary location for this provider.
6. Document the hours of operation, ensuring that you indicate the correct time zone and hours for each day of the week.
7. Confirm your compliance with the Americans with Disabilities Act by answering the relevant questions about accessibility features.
8. Complete the treating categories section by indicating whether the provider treats various conditions listed, such as blindness or physical disabilities.
9. Fill out the associations section if applicable. Provide the name and tax ID of any organizations associated with your practice.
10. Indicate your correspondence and billing addresses, ensuring you fill in the required contact information for each.
11. Provide the administrative contact details. Include the name, job title, telephone number, and email address.
12. If applicable, provide information on telemedicine and laboratory services offered by your practice.
13. Answer the questionnaire regarding your previous participation with BCBSOK.
14. Complete the attachments section by indicating whether you have the required documents, including your Provider NPI number and W-9 form.
15. Sign the attestation section by providing your authorized name, title, tax identification number, and today's date.
16. After completing all sections, review your form for accuracy. After reviewing, save any changes, download, print, or share the form as needed.

Complete your enrollment form online for a smooth onboarding experience with Blue Cross Blue Shield.