Ilinkblue 2025

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The document outlines the iLinkBlue Service Agreement between Louisiana Health Service & Indemnity Company (Blue Cross and Blue Shield of Louisiana) and a provider. It details the terms of access to the iLinkBlue website, responsibilities for maintaining necessary equipment, confidentiality obligations under HIPAA, and conditions for termination and modification of the agreement. Additionally, it includes a Business Associate Addendum that specifies the responsibilities of a business associate in handling protected health information. The document also provides instructions for enrolling in electronic funds transfer (EFT) services and guidelines for managing secure online access.

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Click ‘Get Form’ to open the ilinkblue Service Agreement in the editor.
Begin by filling in the 'Provider Name' and 'Address' sections. Ensure that all details are accurate and match your official records.
Complete the 'Provider Identifiers Information' section, including your Federal Tax Identification Number (TIN) and National Provider Identifier (NPI).
In the 'Financial Institution Information' section, provide your bank's name, routing number, and account details for EFT payments.
Review the 'Submission Information' section. Indicate whether this is a new enrollment and attach a voided check or bank letter as required.
Finally, ensure you sign and date the form before submitting it via email or fax as indicated in the return information section.

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