Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Forms and Documents Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Blue Cross NC Home Providers Forms & documents Providers Forms and documents

   

Provider setup and enrollment changes Demographic Change Form (PDF) Demographic and Contact Information (Job aid) (PDF) Individual Practitioner Enrollment Application Provider Group Enrollment Application Provider Acquisition Form Taxpayer ID Form W9 Tax Identification and Legal Names (Job aid) Terminations of Practitioners and Groups (Job aid) Other forms and documents Applied Behavioral Analysis / Adaptive Behavioral Treatment for Autism Spectrum Disorder (ABA/ABT) Fax Form (PDF) 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 FAQ for Electronic Credentialing and Enrollment Submission (PDF) FAQ for Enrollment Pending Claims Filing Process (PDF) Inpatient Readmission Reconsideration Form Itemized Bill Reconsideration Form Level I Appeals (PDF) Medicare BH Psych Testing Form (PDF) Medicare Level I Appeals (PDF) Member Appeal Representation Authorization Form MY 2025 Provider Reference Guide (PDF) 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) About Us Newsroom Blog Member Forms COVID-19 Transparency in Coverage Find Care Rights & Responsibilities Policies & Best Practices Privacy Policy Website User Agreement Fraud & Abuse Technical Information Contact Us Locations Careers

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

Information in other languages: Español   中文   Tiếng Việt   한국어   Français   العَرَبِيَّة   Hmoob   ру́сский   Tagalog   ગુજરાતી   ភាសាខ្មែរ   Deutsch   हिन्दी   ລາວ   日本語

© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.