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Blue Cross NC Home Providers Forms & documents
Providers Forms and documents

   

Provider Blue Books

Find our commercial, Medicare and dental online reference manuals for providers.

Member Appeal Representation Authorization Form
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 (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)