BCBS of California: How do I register as an out-of-network practitioner? : Reimbursify Customer Care

BCBS of California: How do I register as an out-of-network practitioner? Print

Modified on: Thu, 3 Aug, 2023 at 3:33 PM

Follow the steps below to register as an out-of-network practitioner with BCBS of California:

For Individuals:

Download and complete the for located here: https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/provider/StreamDocumentServlet?fileName=PRV_RA-01_New_Practitioner_Application.pdf
Once complete, attach all required documentation ( licensure/certification and W9) via email at BSCProviderInfo@blueshieldca.com. This form may be completed electronically.

For Groups:

Download and complete the for located here: https://www.blueshieldca.com//bsca/bsc/public/common/PortalComponents/provider/StreamDocumentServlet?fileName=PRV_RA-02_New_Provider_Facility_Application.pdf
Once complete, attach all required documentation ( licensure/certification, proof of legal authorization to use the listed DBA and W9) via email at BSCProviderInfo@blueshieldca.com. This form may be completed electronically.

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BCBS of California: How do I register as an out-of-network practitioner? Print