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1BCBSM Ambulatory Surgery Facility
EON Requirement
Application for an ASF Participation Agreement from Blue Cross Blue Shield of
Michigan is a two-step process. The first step is to obtain Evidence
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How to fill out provider enrollment and change
How to fill out provider enrollment and change
01
Begin by gathering all required documents and information, such as your medical licenses, National Provider Identifier (NPI) number, and contact details.
02
Visit the website of the provider enrollment and change program that you need to fill out. Each program may have a slightly different process, so it's important to refer to the specific instructions provided.
03
Create an account if necessary and log in to the provider enrollment and change portal.
04
Follow the step-by-step instructions provided by the portal to complete each section of the enrollment or change form.
05
Enter accurate and up-to-date information in each required field. Double-check your entries for any errors or omissions.
06
Upload any supporting documents that are requested. Make sure to scan or digitize them beforehand so they can be easily attached to the form.
07
Review the completed form to ensure all information is correct and complete.
08
Submit the form electronically through the portal.
09
Keep a copy of the submitted form and any supporting documents for your records.
10
Monitor the progress of your enrollment or change request through the portal. Follow up with the provider enrollment program if necessary.
11
Once your enrollment or change request is processed and approved, you will be notified through the portal or via email.
12
Make any necessary updates to your practice or billing systems to reflect the changes made through the provider enrollment and change program.
Who needs provider enrollment and change?
01
Healthcare providers who are new to practice and need to enroll with insurance companies and government programs in order to receive reimbursement for their services.
02
Existing healthcare providers who have undergone changes in their practice, such as new locations, change of ownership, additional services, or termination of services.
03
Healthcare providers who want to update their information, such as contact details, licensing information, or specialties.
04
Medical billing companies or organizations that handle billing on behalf of healthcare providers.
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What is provider enrollment and change?
Provider enrollment and change is the process of registering or updating information for healthcare providers to participate in insurance plans or government healthcare programs.
Who is required to file provider enrollment and change?
Healthcare providers such as doctors, hospitals, clinics, and other healthcare facilities are required to file provider enrollment and change.
How to fill out provider enrollment and change?
Provider enrollment and change forms can be filled out online or submitted through mail with required supporting documents.
What is the purpose of provider enrollment and change?
The purpose of provider enrollment and change is to ensure that healthcare providers meet the necessary requirements to participate in insurance plans or government healthcare programs.
What information must be reported on provider enrollment and change?
Provider enrollment and change forms typically require information such as provider's contact details, medical licenses, accreditation, specialization, and practice locations.
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