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Bcbsaz contract application submitter form

Bcbsaz contract application submitter form 2025

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The document is a Provider Change Form for Blue Cross Blue Shield of Arizona (BCBSAZ) that allows healthcare providers to update their information, including address, tax ID, name, and specialty. It emphasizes the importance of submitting changes in writing at least 60 days prior to the effective date to avoid issues with correspondence and claims payments.

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