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Get the free BCBSRI Practitioner Change Form - Blue Cross & Blue Shield of ...

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If more than four practitioners please use additional sheets. Collaborative agreements and requirements are required for nurse practitioners physician s assistants nurse midwives and clinical nurse specialists with prescriptive privileges. IMPORTANT Please verify provider requesting change is participating with BCBSRI before submitting form. This is NOT an application for participation. If provider is not currently participating in the BCBSRI network please visit BCBSRI. PRN is not...
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How to fill out bcbsri practitioner change form

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How to fill out bcbsri practitioner change form

01
Download the BCBSRI Practitioner Change Form from the official BCBSRI website.
02
Fill out the personal information section, including your name, address, and contact details.
03
Provide your BCBSRI provider ID and National Provider Identifier (NPI) numbers.
04
Indicate the effective date of the change in practitioner information.
05
Specify whether it is a solo practitioner or a group practice change.
06
Fill out the necessary information for the new practitioner, including their name, address, and contact details.
07
If applicable, include the new practitioner's BCBSRI provider ID and NPI numbers.
08
Attach any supporting documentation required, such as a letter of employment or termination.
09
Sign and date the form to validate the information provided.
10
Submit the completed form and any supporting documents to the BCBSRI office via mail or fax.

Who needs bcbsri practitioner change form?

01
Healthcare practitioners who are currently affiliated with BCBSRI and need to update their information.
02
Solo practitioners or group practices who want to add or remove a practitioner from their BCBSRI affiliation.
03
Practitioners who have changed their contact information, such as address or phone number, and need to update it with BCBSRI.
04
New practitioners who are joining BCBSRI and need to provide their information for affiliation.
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The bcbsri practitioner change form is a form that allows practitioners to update their information with Blue Cross Blue Shield of Rhode Island.
All healthcare practitioners who are contracted with Blue Cross Blue Shield of Rhode Island are required to file the bcbsri practitioner change form.
The bcbsri practitioner change form can be filled out online through the Blue Cross Blue Shield of Rhode Island website or by submitting a physical form by mail.
The purpose of the bcbsri practitioner change form is to ensure that Blue Cross Blue Shield of Rhode Island has up-to-date information for all contracted healthcare practitioners.
The bcbsri practitioner change form typically requires practitioners to update their contact information, billing information, and any changes to their practice.
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