Initial Dental Credentialing Application - Sanford Health Plan 2026

1. Click ‘Get Form’ to open the Initial Dental Credentialing Application in the editor.
2. Begin by entering your Provider Name and Date at the top of the form. Ensure that these details are accurate as they are essential for identification.
3. Fill in your Practice/Clinic/Facility Name, Email Address, Phone Number, and Fax Number. This information helps establish communication channels.
4. Complete the Physical Address section, including City, State, and ZIP Code. This is crucial for correspondence and verification purposes.
5. Enter your NPI (National Provider Identifier) and Tax ID numbers accurately to avoid any processing delays.
6. Indicate the Name of the Person Completing the Form along with the Date Incident Occurred to ensure accountability.
7. Select the Complaint Type and provide a detailed Complaint Summary. Clearly articulate how BCBSMT can resolve your issue for effective assistance.
8. Once completed, submit the form either by mailing it to PO Box 4309 Attn: Network Management Helena, MT 59604 or emailing it to HCS-x6100@bcbsmt.com.

Start using our platform today to fill out your Initial Dental Credentialing Application quickly and efficiently!