OK BCBS Solo Provider Enrollment Form 2020-2025 free printable template

SOLO PROVIDER ENROLLMENT FORM Complete the form and return to: EMAIL: OKNetworkManagement@bcbsok.com FAX: 9185492141 PHONE: 8007223730 (Option 2)MAIL: Blue Cross and Blue Shield of Oklahoma Attn:

How to fill out OK BCBS Solo Provider Enrollment Form

How to fill out OK BCBS Solo Provider Enrollment Form

1. Begin by downloading the OK BCBS Solo Provider Enrollment Form from the official website.
2. Fill in your personal information including your name, address, and contact details.
3. Provide your National Provider Identifier (NPI) number, if applicable.
4. Indicate your practice type and any specialties you may have.
5. Complete the sections pertaining to your educational background and professional training.
6. Attach any required documents, such as copies of your licenses and certifications.
7. Review the form for accuracy and completeness.
8. Sign and date the form at the designated areas.
9. Submit the form either by mail or online as instructed on the website.

Who needs OK BCBS Solo Provider Enrollment Form?

1. Any healthcare provider who wishes to become a participating provider in the Oklahoma Blue Cross Blue Shield network.
2. Providers who are establishing their practice or expanding their services in conjunction with Blue Cross Blue Shield of Oklahoma.

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What is OK BCBS Solo Provider Enrollment Form?

The OK BCBS Solo Provider Enrollment Form is a document required for individual healthcare providers to enroll as participating providers with Oklahoma Blue Cross Blue Shield (BCBS).

Who is required to file OK BCBS Solo Provider Enrollment Form?

Individual healthcare providers who wish to participate in the Oklahoma Blue Cross Blue Shield network must file the OK BCBS Solo Provider Enrollment Form.

How to fill out OK BCBS Solo Provider Enrollment Form?

To fill out the OK BCBS Solo Provider Enrollment Form, providers must complete all required sections with accurate personal and professional information, attach necessary documentation, and submit the form to Oklahoma BCBS as per their guidelines.

What is the purpose of OK BCBS Solo Provider Enrollment Form?

The purpose of the OK BCBS Solo Provider Enrollment Form is to facilitate the enrollment of individual providers into the BCBS network, allowing them to offer services to BCBS members and receive reimbursement for those services.

What information must be reported on OK BCBS Solo Provider Enrollment Form?

The information that must be reported on the OK BCBS Solo Provider Enrollment Form includes personal identification details, professional qualifications, practice information, and any certifications or licenses relevant to the provider's practice.