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Forms and Documentation

Get the forms you need in one convenient place.

Future BCBSNC Providers

Become a BCBSNC Provider

BCBSNC Providers

Document Description
Ambulance Trip Notes Form (pdf) Record your notes from ambulance trips.
Blue e Account Maintenance Add Users or Providers to Your Blue e Account
Blue e Interactive Network Agreement Signing up for Blue e
Coordination of Benefits Questionnaire (pdf) Streamline claims processing by having member's complete.
Credentialing Apply for credentialing.
Demographic Information (pdf) Complete this form for demographic changes to your practice.
EFT Sign-up Sign up for electronic fund transfers.
Electronic Solutions Agreements, Forms and Instructions
Email Registry Sign-up 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.
Member Appeal Representation Authorization Form (pdf) Authorization form for appeals on the member's behalf.
Prime Therapeutics - Pharmacy Fax Order Form (pdf) New prescription fax order form for PrimeMail.
Provider/Doctor Claim Inquiry (pdf) Form to submit claims questions in writing.
Provider Refund Return Form (pdf) Include this form when returning overpayments to BCBSNC.
Provider Toolkits Access patient assessment and patient educational materials.
ProviderLink Sign-up Sign-up to receive medical record request forms and return medical records to BCBSNC.