Forms and Documentation
Get the forms you need in one convenient place.
Record your notes from ambulance trips.
Add Users or Providers to Your Blue e Account
Signing up for Blue e
Streamline claims processing by having member's complete.
Apply for credentialing.
Demographic Information (pdf)
Complete this form for demographic changes to your practice.
Sign up for electronic fund transfers.
Agreements, Forms and Instructions
Join our email registry for the latest news from BCBSNC.
E-Visit Attestation (pdf)
Document your E-Visits for reimbursement.
E-Visit Vendor Change (pdf)
Notify BCBSNC of a change in your secured electronic channel vendor.
Level I Appeals (pdf)
Complete this form to begin the provider appeal process.
Medicare Level I Appeals (pdf)
Use this form to begin the appeals process for Medicare providers.
Authorization form for appeals on the member's behalf.
New prescription fax order form for PrimeMail.
Form to submit claims questions in writing.
Include this form when returning overpayments to BCBSNC.
Access patient assessment and patient educational materials.
Sign-up to receive medical record request forms and return medical records to BCBSNC.