Providers

Forms and documents

Access provider forms, enrollment applications, reference materials, and other documents used for participating with Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Whether you need to update practice information, enroll a provider or group, submit appeals and authorization requests, or find administrative resources, this centralized collection of forms and documents can help support day-to-day operations and interactions with Blue Cross NC.
Effective October 1, 2025, all reconsideration requests must be submitted exclusively through Blue e. This transition eliminates the need to download forms and submit them via mail or fax.
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Learn More
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Learn more about the reconsideration request transition
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Provider Blue Books
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Find our commercial, Medicare and dental online reference manuals for providers.
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Member Appeal Representation Authorization Form
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Provider setup and enrollment changes

Find forms and resources for provider enrollment, credentialing, demographic updates, tax identification changes, and practice maintenance. Use these documents to add or update providers, make changes to practice information, submit enrollment applications, and notify Blue Cross NC of organizational changes.
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Demographic Change Form (PDF)
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Demographic Change Form (PDF)
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Demographic and Contact Information (Job aid) (PDF)
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Individual Practitioner Enrollment Application
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Individual Practitioner Enrollment Application
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Provider Group Enrollment Application
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Provider Group Enrollment Application
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Provider Acquisition Form
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Taxpayer ID Form W9 (PDF)
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Taxpayer ID Form W9 (PDF)
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Terminations of Practitioners and Groups (Job aid)
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Other forms and documents

Browse a variety of provider forms, reference guides, appeals documentation, authorization request forms, electronic solutions resources, and administrative materials. These documents support common provider activities, including claims and payment inquiries, prior authorization requests, provider account management, medical record submissions, and participation in Blue Cross NC programs.
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Annual Provider Update Brochure (PDF)
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Applied Behavioral Analysis / Adaptive Behavioral Treatment for Autism Spectrum Disorder (ABA/ABT) Fax Form (PDF)
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Applied Behavioral Analysis / Adaptive Behavioral Treatment for Autism Spectrum Disorder (ABA/ABT) Fax Form (PDF)
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BetterDoctor FAQ
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Blue e Account Maintenance
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Blue e Interactive Network Agreement
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Coding Dispute Form (PDF)
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Coding Dispute Form (PDF)
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Commercial Intensive Outpatient Program (IOP) Authorization Request Form (PDF)
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Commercial Intensive Outpatient Program (IOP) Authorization Request Form (PDF)
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Commercial Partial Hospitalization Programs (PHP) Authorization Request Form (PDF)
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Commercial Partial Hospitalization Programs (PHP) Authorization Request Form (PDF)
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Coordination of Benefits Questionnaire (PDF)
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Coordination of Benefits Questionnaire (PDF)
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Electronic Solutions
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Email Registry Sign-Up
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FAQ for Electronic Credentialing and Enrollment Submission (PDF)
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FAQ for Electronic Credentialing and Enrollment Submission (PDF)
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FAQ for Enrollment Pending Claims Filing Process (PDF)
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FAQ for Enrollment Pending Claims Filing Process (PDF)
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Level I Appeals (PDF)
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Level I Appeals (PDF)
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Medicare Level I Appeals (PDF)
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Medicare Psychological and Neuropsychological Testing Prior Authorization Request Form (PDF)
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Medicare Psychological and Neuropsychological Testing Prior Authorization Request Form (PDF)
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Medicare Waiver of Liability (PDF)
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Medicare Waiver of Liability (PDF)
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Member Appeal Representation Authorization Form
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MY 2026 Provider Reference Guide (PDF)
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Post Service - Ambulance Trip Sheet Form (PDF)
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Post Service - Ambulance Trip Sheet Form (PDF)
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Post Service - Hemodialysis Treatment for ESRD Form (PDF)
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Post Service - Medical Records Fax Sign-Up Form (PDF)
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Post Service - Intraoperative Neurophysiologic Monitoring Form (PDF)
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Post Service - Intraoperative Neurophysiologic Monitoring Form (PDF)
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Provider / Doctor Claim Inquiry (PDF)
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Provider Refund Return Form (PDF)
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