Get Regence Bluecross Blueshield Of Utah Practitioner Credentialing Application
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How to fill out the Regence BlueCross BlueShield Of Utah Practitioner Credentialing Application online
Filling out the Regence BlueCross BlueShield of Utah Practitioner Credentialing Application online is an essential step for healthcare professionals seeking to join the provider network. This guide provides detailed, step-by-step instructions to assist you through the process effectively.
Follow the steps to complete the credentialing application accurately.
- Click ‘Get Form’ button to obtain the form and access it in the online editor.
- Begin by entering your personal details in the appropriate fields, including your first name, last name, and email address. Ensure that all information is accurate, as this will be used for confirmations and documentation.
- Complete the application by filling out all required sections thoroughly. Keep in mind that incomplete applications may lead to delays in processing your credentialing.
- Attach a copy of your CP 575 or 147C letter from the Internal Revenue Service. This is necessary for tax identification verification.
- After filling in the application, ensure that you sign the required pages (10, 11, and 12) electronically.
- Once you have completed the application and signed the necessary pages, return the entire application along with the supporting documentation. You can do this via email or fax as instructed in the application guidelines.
- Retain a copy of the completed application and all submitted documentation for your records.
- Finally, be prepared to monitor the status of your application. You may inquire about your application status through the Credentialing department if needed.
Start filling out your Regence BlueCross BlueShield of Utah Practitioner Credentialing Application online today!
Premera and Regence are separate companies. Premera and Regence are each independent licensees of the Blue Cross and Blue Shield Association. Through various collaborative agreements, some Regence members could have been affected.
Fill Regence BlueCross BlueShield Of Utah Practitioner Credentialing Application
We are now processing credentialing applications submitted on or before June 17, 2025. Completion of the credentialing process takes 30-60 days. Complete the application online in its entirety and print it. 3. Sign pages 11 and 13 and return them along with a copy of your CP 575 or 147C letter and. The document is a credentialing application for healthcare practitioners seeking to join the Regence BlueCross BlueShield of Utah provider network. It's easy to become a participating dental provider. Please review the checklist below before completing and submitting your application. Credentialing applications are processed within 90 days of receipt of a complete application. To serve Blue Cross Blue Shield members, you must be contracted with the local Blue Cross Plan where your practice is located.
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