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- Demographic Change Form (PDF)
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- Individual Practitioner Enrollment Application
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Taxpayer ID Form W9 - Taxpayer ID Form W9 (Job aid)
- Tax Identification and Legal Names (Job aid)
- Terminations of Practitioners and Groups (Job aid)
- Applied Behavioral Analysis / Adaptive Behavioral Treatment for Autism Spectrum Disorder (ABA/ABT) Fax Form (PDF)
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BetterDoctor FAQ - Blue e Account Maintenance
- Blue e Interactive Network Agreement
- Commercial Intensive Outpatient Program (IOP) Authorization Request Form (PDF)
- Commercial Partial Hospitalization Programs (PHP) Authorization Request Form (PDF)
- Coordination of Benefits Questionnaire (PDF)
- Electronic Solutions
- Email Registry Sign-Up
- Facility Emergency Department Level Reconsideration Form (PDF)
- FAQ for Electronic Credentialing and Enrollment Submission (PDF)
- FAQ for Enrollment Pending Claims Filing Process (PDF)
- Inpatient Readmission Reconsideration Form (PDF)
- Itemized Bill Reconsideration Form (PDF)
- Level I Appeals (PDF)
- Medicare BH Psych Testing Form (PDF)
- Medicare Level I Appeals (PDF)
- Member Appeal Representation Authorization Form
- Post Service - Ambulance Trip Sheet Form (PDF)
- Post Service - Dermatology Patch Allergy Testing Form (PDF)
- Post Service - Hemodialysis Treatment for ESRD Form (PDF)
- Post Service - Medical Records Fax Sign-Up Form (PDF)
- Post Service - Intraoperative Neurophysiologic Monitoring Form (PDF)
- Post Service - Nerve Fiber Form (PDF)
- Provider / Doctor Claim Inquiry (PDF)
- Provider Refund Return Form (PDF)
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