Providers and practices who are going through an acquisition or are acquiring another practice are required to report any changes to Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
The form below is the easiest way to report acquisitions and buyouts and provide us with the necessary information to process your acquisition.
All acquisitions must be reported at least 60 days before the effective date.
Who should complete the form?
- Entities who are acquiring a new provider/practice
- Entities merging with another provider
- Entities participating in a buyout
- In- and out-of-network providers
What is required to complete the form?
- Provider W-9 - accepted formats: jpg jpeg png pdf
- Official Documentation of Acquisition - accepted formats: jpg jpeg png pdf
- Provider Roster - accepted formats: excel