Get Az Provider Contracting Request And Information Form 2014-2025

Completing the AZ Provider Contracting Request and Information Form is a vital step in becoming a contracted provider with Blue Cross Blue Shield of Arizona Advantage. This guide offers step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to obtain the form and launch it in your preferred editing tool.
2. Read through the instructions on the form carefully to understand what information is required for each section.
3. If you have a CAQH ID, enter it in the specified field to simplify your application process. If you do not have a CAQH ID, prepare to fill out all sections of the form.
4. Complete pages 1-3 fully. Ensure all required fields are filled to prevent delays.
5. Provide the necessary supporting documentation, which includes a curriculum vitae for the last five years and a current malpractice insurance certificate.
6. Navigate to the release and attestation section on page 8. Read it carefully and ensure you understand your commitments.
7. Sign the attestation electronically and include the date of submission.
8. After completing the form, review all entries for accuracy before saving.
9. Choose to save your changes, download or print the form for your records, or share it as required.

Complete your AZ Provider Contracting Request and Information Form online today.