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All providers (as defined by the provider specialties listed below) must be enrolled and credentialed by Blue Cross and Blue Shield of Alabama and practice in an acceptable professional location that ensures confidentiality of procedures and minimal risk to members. Note: Providers outside of Alabama must be participating with their local Blue Plan for consideration for participation with Blue Cross and Blue Shield of Alabama.

Please follow the steps below:

Step 1 - Required Documents for All Providers/Specialties

There are several required documents that you must submit for enrollment. Print this handy checklist (Practitioner or Facility/Business) to track your progress throughout enrollment and ensure that all necessary documents/forms are submitted. Some of the required forms are provided in step 3. 

Step 2 - National Provider Identifier (NPI) - Required 

All providers eligible for an NPI are required to obtain one. Visit the National Plan and Provider Enumeration System (NPPES) website for instructions on how to request an NPI.

Step 3 - Provider Enrollment Application/Supporting Documents

Click on the appropriate specialty from the list below to view and print the application and list of supporting documents necessary for enrollment. By utilizing the proper application and returning the correct supporting documents, you can significantly speed up the enrollment process. Submit all current supporting documentation in a legible format.

An application and supporting documents from this section are also needed for a provider who:

• Is practicing within the state of Alabama and needs to be enrolled for claims processing.
• Is joining an existing tax identification number (excluding MDs and DOs, DPMs and ODs - see Provider Maintenance.)

Applications/Supporting Documentation Requirements

• Ambulatory Surgery Center (ASC)
• Ancillary Providers NOT LOCATED IN ALABAMA
• Anesthesiologist Assistants
• Audiologists
• Behavioral Health Provider - Contact Lucet at 1-888-611-6285
• Hearing Instrument Specialists
• Certified Registered Nurse Anesthetist (CRNA)
• Chiropractor
• Dentist (General)
• Dentist (Out-of-State)
• Dietitian
• Durable Medical Equipment (DME) and other suppliers
• Endodontist
• Ground Ambulance
• Healthcare Facility Application
• Home Health
• Home Infusion
• Hospice
• Independent Laboratory
• Nurse Midwife
• Nurse Practitioner
• Occupational Therapist
• Optical Dispensary
• Optician
• Optometrist
• Oral Surgeon
  • Uniform Provider Application (UPA) and Dental Provider Application
• Periodontist
• Physical Therapist
• Physician Assistant
• Physicians (MD or DO)
• Physician Laboratory
• Podiatrist
• Prosthodontist
• Speech Language Pathologist
• Not Listed Above

Step 4 - Express Your Network Interest

Complete the Practitioner Network Interest Form  or the Facility Business Network Interest Form that is included with the application for your specialty. It is required for all new applications and expresses your interest in network participation. After the enrollment and credentialing process is complete, a provider will be reviewed and invited to participate in a network if all criteria are met.

Note:

• Enrollment is not the same as joining a Blue Cross Provider Network.
• Enrollment and expressed interest in network participation are not a guarantee of acceptance as a participant in a network.

Practitioner Rights

Questions?

View our CAQH Frequently Asked Questions/Answers.

Missing a Form or Document?

Visit our Provider Maintenance page for quick access to miscellaneous forms, such as the Practitioner Network Interest Form, Facility Business Network Interest Form,  Hospital Data Form, Request for Taxpayer Identification Number, or PRP New Physician Notification.. 

Access all forms that are required for new and existing providers with either the Practitioner Application Package or the Facility Business Application Package.

Existing Providers
If you are adding a location or making other changes, go to Provider Maintenance for instructions and forms.