Download and submit Blue Shield forms that help you and your office meet credentialling requirements and other procedures. You'll need Adobe Reader to view the forms.


Behavioral Health Facility Application (PDF, 486 KB)

Behavioral Health Practitioner Application (PDF, 1,170 KB)

Health Delivery Organization Application (PDF, 97 KB)

Individual Practitioner Information Change Form (PDF, 998 KB)

Individual Practitioner Record Application (PDF, 741 KB)

Provider Credentialing Application (PDF, 757 KB)

Provider Dispute Resolution - Facility (PDF, 72 KB)

Provider Dispute Resolution - Professional (PDF, 72 KB)

Provider Group/Facility Information Change Form (PDF, 1.1 MB)

Provider Group/Facility Record Application (PDF, 788 KB)

Provider Recredentialing Application (PDF, 744 KB)