Create your Bcbs provider Application Form from scratch

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Here's how it works

01. Start with a blank Bcbs provider Application Form
Open the blank document in the editor, set the document view, and add extra pages if applicable.
02. Add and configure fillable fields
Use the top toolbar to insert fields like text and signature boxes, radio buttons, checkboxes, and more. Assign users to fields.
03. Distribute your form
Share your Bcbs provider Application Form in seconds via email or a link. You can also download it, export it, or print it out.

Design your Bcbs provider Application Form in a matter of minutes

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Step 1: Access DocHub to set up your Bcbs provider Application Form.

Start by logging into your DocHub account. Explore the pro DocHub functionality at no cost for 30 days.

Step 2: Navigate to the dashboard.

Once logged in, head to the DocHub dashboard. This is where you'll build your forms and manage your document workflow.

Step 3: Design the Bcbs provider Application Form.

Click on New Document and choose Create Blank Document to be taken to the form builder.

Step 4: Design the form layout.

Use the DocHub features to add and arrange form fields like text areas, signature boxes, images, and others to your document.

Step 5: Insert text and titles.

Add necessary text, such as questions or instructions, using the text field to guide the users in your form.

Step 6: Configure field settings.

Modify the properties of each field, such as making them required or formatting them according to the data you plan to collect. Assign recipients if applicable.

Step 7: Review and save.

After you’ve managed to design the Bcbs provider Application Form, make a final review of your document. Then, save the form within DocHub, export it to your preferred location, or share it via a link or email.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
If you have questions regarding the Anthem provider application process, please call 1-800-992-BLUE (2583), and select the following prompts: Option 1: Medical Providers. Option 4: Updates and Other Information.
Become a Network Provider Correctly and completely submit the credentialing application and required documentation. Be fully credentialed by Anthem. Sign and return all contract documents, as applicable. New groups/providers will receive a Participating Health Provider Agreement (contract).
If you are not sure if your group or practice is contracted with Anthem, please call Provider Services at 1-800-450-8753 to inquire.
By Phone: Call the number on the back of the members ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative.
All Providers are required to submit an application and provide qualifications and credentials verification in order to obtain a Blue Cross Blue Shield of Mississippi Provider Number and/or apply for Provider Network participation. A Provider Number is required before claims can be submitted.
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Related Q&A to Bcbs provider Application Form

You can also call a representative at 800-300-8181 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. and on Saturday from 9 a.m. to 5 p.m. Eastern time.
Credentialing Process Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org . Authorize Anthem so we can access your credentialing information. Review and update your application.
Credentialing: Submit your CAQH request form or completed initial credentialing application to Blue Shields Credentialing Department. Credentialing applications and corresponding information are reviewed and formally approved or denied by Blue Shields Credentialing Committee.

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