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Regence BlueCross BlueShield of Utah Practitioner Credentialing Application

Regence BlueCross BlueShield of Utah Practitioner Credentialing Application 2026

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The document is a credentialing application for healthcare practitioners seeking to join the Regence BlueCross BlueShield of Utah provider network. It outlines the requirements for credentialing, including submission of personal and professional information, supporting documents, and compliance with credentialing criteria. The application process involves providing contact details, completing various sections about professional history, education, licensure, and malpractice coverage. Practitioners must also attest to their qualifications and authorize investigations into their credentials. The document emphasizes the importance of accuracy in submissions and provides instructions for electronic submission.

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Click ‘Get Form’ to open the Regence BlueCross BlueShield of Utah Practitioner Credentialing Application in our editor.
Begin by entering the email address and name of the individual responsible for reviewing and signing your agreement documents. This is crucial to avoid delays.
Complete each section of the application, ensuring all fields are filled out accurately. Use black or blue ink if printing, or type directly in our platform.
Attach required documents such as your CP 575 or 147C letter from the IRS. If you lack these documents, contact the IRS for assistance.
Sign pages 10, 11, and 12 electronically within our editor. Ensure all supporting documentation is included before submission.
Submit your completed application via email or fax as instructed, retaining a copy for your records.

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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.

What is the phone number for Regence credentialing?

If the information you need is not available in the Onboarding Tracker, call our Provider Contact Center at 1 (888) 349-6558. 6. View additional information about credentialing and contracting in our Self-Service Tool, on our provider website, regence.com.

What is the phone number for Regence Blue Shield of Idaho provider relations?

When calling our Provider Contact Center at 1 (800) 253-0838, use the phone prompts below to access IVR: If your patient is a Regence member, press 1 and select: For questions regarding dental. For prescription pre-authorization questions.

How long does Blue Cross credentialing take?

Plan and allow appropriate time If you are starting a new practice or hiring a new provider for your existing practice, allow an appropriate amount of time to complete your credentialing process. A safe estimate would be to allow 120 days to complete the process for each of the payors that you enroll with.

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