Provider Enrollment and Change Self-Service is an application for group administrators within the provider portal.

With it, you can update your information with us and enroll new practitioners within your group.

Who can use it

Group administrators who maintain data for health care practitioners and allied provider groups can use this app.

These professional health care practitioner groups include:

• Physicians
• Mid-level practitioners
• Behavioral health practitioners
• Vision and hearing practitioners

Allied provider groups include:

• Ambulance
• Clinical independent laboratories
• Durable medical equipment suppliers
• Prosthetic and orthotic suppliers
• Vaccine pharmacies

Only those with Type 2 NPIs who are responsible for maintaining group information with us should register for this app. Independent practitioners who aren’t part of a group or facility providers can’t use this self-service app.

What you can do

Here's a list of services you can complete with this application based on your provider type:

Professional groups and allied providers

• Add or remove practice locations
• Add or remove network participation
• Change primary, remit, mailing address or tax ID
• Maintain office hours and location services
• Maintain location contact information
• Terminate groups and allied providers

Practitioners in professional groups

• Enroll or remove practitioners with group
• Move practitioners between groups
• Maintain practice locations within group
• Maintain Blue Care Network PCP status with group
• Move members when BCN PCP disaffiliates
• Maintain BCN Managed Care Group affiliations with your group

How to sign up

You'll need to have access to the provider portal. Not yet registered? Learn how to get an account.

Once you have access, you'll need to fill out and send us this form:

• Addendum G (PDF)