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Learn moreProfessional Provider Enrollment:
Independent Physical Therapist
To join BCBSM Traditional, Blue Preferred TRUST (PPO), Blue Choice (POS), BCN HMO and/or BCN Advantage, please complete these forms and submit them to the address(es) listed. The prior BCBSM Independent Physical Therapist Affidavit has been replaced by the BCBSM Independent Physical Therapist Certification form below.
BCBSM Traditional and/or BCN
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All applicants, BCBSM and BCN, please complete this form::
BCBSM applicants — complete these additional forms:
To enroll with BCN — this form is required:
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TRUST PPO
To enroll in our TRUST PPO network, you must also complete additional enrollment steps.
Questions? We can help!
If you need additional information, please contact us.
