Bcbs mental health practicioner nrollment form 2025

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4.2 out of 5

109 votes

The document provides detailed instructions for completing and submitting a fax cover sheet for new practitioner enrollment with Blue Cross Blue Shield of Michigan and Blue Care Network. It emphasizes the importance of using typed information only, outlines required fields for individual practitioners, allied providers, and group practices, and specifies submission procedures to avoid processing delays. Additionally, it includes sections for demographic data, tax information, specialty details, network applications, address data, secured services access, and application signature requirements.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (60 Votes)
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