Get Ok Bcbs Solo Provider Enrollment Form 2020-2025

Completing the OK BCBS Solo Provider Enrollment Form is an important step for healthcare providers looking to enroll with Blue Cross Blue Shield of Oklahoma. This guide provides clear, step-by-step instructions to assist you in filling out the form online efficiently and accurately.

Follow the steps to complete your enrollment form.

1. Click ‘Get Form’ button to access the enrollment form and open it for editing.
2. Begin with the submitter information section. Fill in the required fields marked with an asterisk (*), including your first name, last name, email address, telephone number, job title or position, and network participation choice.
3. In the practitioner information section, indicate if you are currently in a residency program. Then, provide details about your primary provider type, specialty, license number, and Tax Identification Number (TIN).
4. Next, fill out your personal information, including your date of birth, gender, and any titles you hold. Ensure to provide an accurate description that reflects your identity.
5. In the additional personal and practitioner information section, select your applying status and provide details such as your Medicare number and DEA number if applicable. Answer questions about hospital admitting privileges and cultural competency training.
6. Complete the office physical location section by providing the location name, contact name, address, and multiple operational details including patient services offered and hours of operation.
7. Confirm compliance with the Americans with Disabilities Act and provide information on the treating categories.
8. Fill out the associations section if applicable, providing names, site numbers, and Tax IDs for any relevant partnerships.
9. Specify your correspondence, billing, and credentialing addresses, ensuring to mark if they are the same as the office physical location.
10. Provide information about your administrative contact including name, title, and contact information.
11. Detail your practice information, specifying if you offer telemedicine and lab services, and answer the related questionnaire.
12. Attach any required documents, ensuring you mark whether each document is included.
13. Complete the attestation section, entering the authorized name, title, TIN, and the current date.
14. Once all sections of the form are filled out, review your entries for accuracy. Finally, save changes, download, print, or share the completed form as needed.

Now that you are equipped with the necessary steps, start filling out the OK BCBS Solo Provider Enrollment Form online today.