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
Get information about what must be included when submitting a change about your organization.
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.
© 2024 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.