Resources

We continually update as well as develop educational documents to assist our network providers with their Blue Cross needs.

Plus sign that becomes an "X" when the accordion collapses to show more content Forms

Admissions and Recertifications Form
Alternative Dental Procedure Payment Responsibility Form
Authorization Form
Behavioral Health Provider Clinical Profile Form
Claims Dispute Form
Consumer's Right to Know Facility Reporting Form
Continuity of Care Request Form
Coordination of Benefits Questionnaire
Electronic Funds Transfer Application
Electronic Funds Transfer Termination or Change Form
Electronic Remittance Advice (ERA) Enrollment Form
Health Delivery Organization (HDO) Form
Health Delivery Organization (HDO) Reverification Form

How to Request Act 897 Provisions
iLinkBlue Agreement Packet
Louisiana Standardized Credentialing Application
Recredentialing Application
Overpayment Notification Form
Prepay Facility Audit Cover Sheet
Professional Liability Information Form
Provider Update Form

Release of Protected Health Information Form
Request for Taxpayer Identification Number and Certification
Utilization Management Approval and Denial Fax Form