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Speed Guides
Tidbits
Workshop and Webinar Presentations
Past Workshops
2023 Professional Workshop
Recent Webinars
2024 New to Blue Webinar - Professional
2024 New to Blue Webinar - Facility
2024 Provider Credentialing and Data Management
2023 Sleep Management Program Webinar
2023 Provider Credentialing and Data Management
2023 Behavioral Health – Facility
2023 Behavioral Health – Professional
2022 New Security Setup Application Webinar
2022 Laboratory Benefit Management Program
2019 CES Webinar - Professional
Forms
Admissions and Recertifications Form
Alternative Dental Procedure Payment Responsibility Form
Authorization Form
Behavioral Health Provider Clinical Profile Form
Blue Cross CAA Consent Submission Form
Consumer's Right to Know Facility Reporting Form
Continuity of Care Request Form
Coordination of Benefits Questionnaire
Electronic Funds Transfer Application
Electronic Remittance Advice (ERA) Enrollment Form
Itemized Bill Cover Sheet
No Surprises Act Open Negotiation Notice
OGB Bariatric Surgery Form
Overpayment Notification Form
Professional Liability Information Form
Provider Disputes Form
Rainmaker Application Form
Reimbursement During Credentialing
Release of Protected Health Information Form
Retrospective Review Authorization Form
Utilization Management Approval and Denial Fax Form
The documents below are available in DocuSign® format only. The PDF versions of these forms are no longer available. Submitting these forms in the DocuSign format allows the Provider Credentialing & Data Management staff to efficiently process your requests. For details on completing DocuSign forms, view this guide. When submitting DocuSign documents, please do not separately email them to Blue Cross. We automatically receive your submission from the DocuSign application. Double submissions (submitting through DocuSign and also sending an email of the completed form) could delay the processing time for your request.
Your request can take up to 90 days to process once all required information has been received. Providers will remain non-participating in our networks until their credentialing application has been approved by the credentialing committee and an executed contract is in place.
DocuSign Format
iLinkBlue Agreement Packet
Professional Initial Credentialing Packet
(now includes LCSA Attachment A)
Facility Credentialing Packet
(now includes all HDO Attachments)
New/Revised Medical Policies
Effective May 1, 2024
Revised Policy No. 00130 – Transcatheter Uterine Artery Embolization
Revised Policy No. 00131 – Ultraviolet Light Therapy Delivery Devices for Home Use
Effective July 1, 2024
Revised Policy No. 00218 – Rituximab Products
Revised Policy No. 00313 – Manipulation Under Anesthesia
Revised Policy No. 00577 – Laboratory Testing Investigational Services
Revised Policy No. 00817 – Bevacizumab Products
Revised Policy No. 00818 – Trastuzumab Products
New/Revised Lab Reimbursement Policies
Revised Policy
Effective for dates of service on and after July 15, 2024:
New Policies
Effective for dates of service on and after March 1, 2024:
Revised Policies
Effective for dates of service on and after Nov. 1, 2023
