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MI BCBS NPI Dissemination Form for BCBSM free printable template

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NPI Dissemination Form for BC BSM Medicare NPS for Professional Providers If you have any professional NPS* that you registered with Medicare but did not register with BC BSM, please send them to
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How to fill out MI BCBS NPI Dissemination Form for BCBSM

01
Obtain the MI BCBS NPI Dissemination Form from the BCBSM website or your provider portal.
02
Fill in your National Provider Identifier (NPI) number in the designated field.
03
Provide your contact information, including your name, address, phone number, and email.
04
Include your tax identification number (TIN) as required.
05
Specify the type of services you provide and the locations where you practice.
06
Review the form for accuracy and completeness before submission.
07
Sign and date the form to certify that the information is correct.
08
Submit the completed form to BCBSM via the specified submission method (email, fax, or online submission).

Who needs MI BCBS NPI Dissemination Form for BCBSM?

01
Healthcare providers who are enrolled with Blue Cross Blue Shield of Michigan (BCBSM).
02
Organizations that bill BCBSM for services provided to patients.
03
Providers who need to update or disseminate their NPI information to BCBSM.
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The MI BCBS NPI Dissemination Form for BCBSM is a document used by healthcare providers in Michigan to report their National Provider Identifier (NPI) information to Blue Cross Blue Shield of Michigan (BCBSM).
Healthcare providers who are billing BCBSM for services rendered, including individual practitioners and organizations, are required to file the MI BCBS NPI Dissemination Form.
To fill out the MI BCBS NPI Dissemination Form, providers must provide their NPI number, basic identification information, and any additional required details as outlined in the form's instructions.
The purpose of the MI BCBS NPI Dissemination Form is to ensure that BCBSM has accurate and up-to-date provider information for billing and claims processing.
The information that must be reported includes the provider's NPI number, full name, business address, contact information, and any other details specified in the form.
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