FL Florida Blue Non-Participating Provider Registration free printable template

Mail to: Florida Blue Network Operations P.O. Box 41109 Jacksonville, FL 32203 Fax to: 9043011884 Nonparticipating Provider Registration Form Registration Type: Group/Organization (skip section 2)

How to fill out FL Florida Blue Non-Participating Provider Registration

How to fill out FL Florida Blue Non-Participating Provider Registration Form

1. Obtain the FL Florida Blue Non-Participating Provider Registration Form from the Florida Blue website or a local office.
2. Fill out the provider identification section, including your name, practice name, and contact information.
3. Provide your National Provider Identifier (NPI) number.
4. Complete the section detailing your practice location(s) and the type of services you provide.
5. Indicate whether you have any existing contracts with Florida Blue or other insurers.
6. Review the form for accuracy and completeness.
7. Sign and date the form.
8. Submit the completed form to Florida Blue via the specified submission method (mail, fax, or online submission).

Who needs FL Florida Blue Non-Participating Provider Registration Form?

1. Healthcare providers who wish to bill Florida Blue for services rendered to patients who are Florida Blue members but do not wish to enter a participating provider agreement.
2. Providers who want to ensure they can receive reimbursements from Florida Blue for non-participating services.
3. New providers starting their practice seeking to establish a non-participating status with Florida Blue.

People Also Ask about

What is the phone number for Florida Blue provider authorization?

If your provider has any questions, they should call us at 1-800-727-2227. Please note: Services, procedures or medications that may not require prior approval may be subject to medial review and medical coverage guidelines.

How do I get an authorization from Florida Blue?

If you don't have access to Availity or if the system isn't available, you can request authorizations and referrals through our automated phone system, Blue Express, at (800) 397-7337.

How long does it take to get credentialed with Florida Blue?

We typically see the credentials verification process completed in 60 – 90 days and the contracting phase complete in another 30 days for a total of 90 – 120 days from the time an insurance company receives the providers credentialing application.

Does Florida Blue requirements authorization?

Prior Authorization is required before these drugs are administered in these locations: a doctor's office, at home, outpatient hospital, ambulatory surgical center or a health clinic. Prior Authorization is not required in an emergency room, inpatient hospital or an urgent care center.

How do I contact Florida Blue credentialing?

You can reach us by phone at 800-352-2583 or chat live with us by clicking Chat. Or you can call 877-352-5830 to be automatically routed to your local Florida Blue Center.

What is the phone number for Florida Blue medication prior authorization?

Your doctor must contact Florida Blue at 1-877-719-2583 or its delegate at (800) 424-4947 at MagellanRx Management.

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What is FL Florida Blue Non-Participating Provider Registration Form?

The FL Florida Blue Non-Participating Provider Registration Form is a document that allows healthcare providers who do not participate in the Florida Blue insurance network to register and provide services to insured patients.

Who is required to file FL Florida Blue Non-Participating Provider Registration Form?

Healthcare providers who wish to offer services to Florida Blue members but do not have a contractual agreement with Florida Blue are required to file the FL Florida Blue Non-Participating Provider Registration Form.

How to fill out FL Florida Blue Non-Participating Provider Registration Form?

To fill out the FL Florida Blue Non-Participating Provider Registration Form, providers should complete all required fields accurately, including personal information, practice details, and any relevant insurance information, and submit it as instructed by Florida Blue.

What is the purpose of FL Florida Blue Non-Participating Provider Registration Form?

The purpose of the FL Florida Blue Non-Participating Provider Registration Form is to facilitate the registration of providers who are not in-network with Florida Blue, enabling them to offer services to members and receive reimbursement.

What information must be reported on FL Florida Blue Non-Participating Provider Registration Form?

The information that must be reported on the FL Florida Blue Non-Participating Provider Registration Form includes the provider's name, address, tax identification number, contact information, specialties, and any relevant licensure or certification details.