For Providers: Enroll in our network

next Hospitals and Facilities

Please review the Facility Enrollment Required Document Checklist (PDF) for your classification type and ensure that you have all the needed information readily available to avoid processing delays.

For home health care and skilled nursing facility providers, please review the Home Health Care and Skilled Nursing Facility Change of Ownership Helpful Hints (PDF).

next Physicians and Professionals

Please review the Required Document Checklist (PDF) for your classification type and ensure that you have all the needed information readily available to avoid processing delays.
For Michigan providers new to Blue Cross and BCN, please review the Enrollment Helpful Hints (PDF).
For providers located outside of Michigan and new to Blue Cross and BCN, please review the Enrollment Helpful Hints for New Ancillary Providers Located Outside of Michigan (PDF).
For new behavioral health providers, please see the Enrollment Helpful Hints (PDF) and Behavioral Health Eligibility and Type Grid (PDF).
For Non-Michigan/Out-of-State provider EFT enrollment: (PDF).

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Which action do you need to perform?

In addition to listing documents needed to complete your request, the Required Document Checklist contains a list of items you should have available in order to complete the needed forms. Please review the checklist before you begin.

Enroll a new provider Enroll a new provider

Change an existing provider Change an existing provider

Terminate an existing provider Terminate an existing provider

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What type of facility are you?

Facilities

: Ambulatory Infusion Centers
: Ambulatory Surgical Facilities
: End Stage Renal Disease Facilities
: Federally Qualified Health Centers
: Freestanding Radiology Center
: Halfway House Facilities
: Home Health Care Facilities
: Home Infusion Therapy Facilities
: Hospice Facilities
: Hospitals
: Long-Term Acute Care Hospital
: Outpatient Physical Therapy Facilities
: Outpatient Psychiatric Care Facilities
: Psychiatric Residential Treatment Facilities
: Retail Health Center
: Rural Health Clinic
: Skilled Nursing Facilities
: Substance Abuse Facilities

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What type of provider are you?

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Select one or more classifications below representing practitioner members of the Group:

Practitioners

: Doctor of Medicine
: Doctor of Osteopathy
: Chiropractor
: Podiatrist

Mid-level (health care) Practitioners

: Acupuncturist
: Athletic Trainer
: Certified Nurse Midwife
: Certified Nurse Practitioner
: Clinical Nurse Specialist-Certified
: Certified Registered Nurse Anesthetist
: Genetic Counselor
: Physician Assistant

Allied Health Practitioners

: Independent Occupational Therapist
: Independent Physical Therapist
: Independent Speech Language Pathologist

Behavioral Health

: Fully Licensed Psychologist
: Licensed Behavior Analyst
: Licensed Marriage and Family Therapist
: Licensed Master Social Worker
: Licensed Professional Counselor
: Limited Licensed Psychologist
: Psychiatrist

Hearing

: Audiologist
: Hearing Aid Dealer

Vision

: Ophthalmologist
: Optometrist

Dental

: Dentist
: Oral Surgeon (Medical/Surgical only)

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Is the practitioner an incorporated individual?
Yes No

Do you wish to add the new practitioner to an existing Professional Group?
Yes No

Is the practitioner applying to provide behavioral health
services?
Yes No

Does practitioner provide behavioral health
services?
Yes No

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Save time on future group updates by registering for the new Provider Enrollment and Change Self-Service application.

Practitioner forms and documents

Provider Enrollment and Change Self-Service
Sign and return
Save for your records
Completed

[ - ] BCBSM agreements and signature documents BCBSM Contracts

[ - ] BCBSM/BCN agreements and signature documents BCBSM Contracts

[ - ] BCBSM agreements and signature documents - For Independent Occupational Therapist BCBSM Contracts

[ - ] BCBSM agreements and signature documents - For Independent Speech Language Pathologist BCBSM Contracts

[ + ] BCN agreements and signature documents BCN Contracts

BCN agreements and signature documents
BCN will send contracts under separate cover as applicable upon receipt and review of your application materials.

[ + ] Provider Web and electronic services

Doing business electronically saves your office time and money. See what services we offer to streamline your business processes and make doing business with us easier:

Find out more about registering for Availity® Essentials.
Electronic Funds Transfer (EFT) - for BCBSM professional providers only
Electronic Connectivity (EDI)

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Back to Enrollment and Changes

[ - ] BCBSM agreements and signature documents BCBSM contracts

[ - ] BCN agreements and signature documents BCBSM contracts

BCBSM agreements and signature documents
BCBSM will send contracts under separate cover as applicable upon receipt and review of your application materials.

BCN agreements and signature documents
BCN will send contracts under separate cover as applicable upon receipt and review of your application materials.

BCBSM/BCN agreements and signature documents
BCBSM will send contracts under separate cover as applicable upon receipt and review of your application materials.

[ + ] Provider Web and electronic services

Doing business electronically saves your office time and money. See what services we offer to streamline your business processes and make doing business with us easier:

Find out more about registering for Availity® Essentials.
Electronic Funds Transfer (EFT) - for BCBSM professional providers only
Electronic Connectivity (EDI)

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[an error occurred while processing this directive]

Join our Network

Which action do you need to perform?

What type of facility are you?

What type of provider are you?

Select one or more classifications below representing practitioner members of the Group:

Practitioner forms and documents