Documents and forms

This is everything you need to the complete Blue Shield Network Provider application, including instructions and forms, based on your specialty.

Chiropractor

Application cover letter (DOCX, 40 KB)

 California Participating Practitioner Application (PDF, 401 KB)

Packet Literature (PDF, 476 KB)

Allied provider agreement (PDF, 541 KB) and appropriate record application as outlined below.

Other specialists

Acupuncturist, Anesthetist, Audiologist, Dispensing Optician, Hearing Aid Supplier, Occupational Therapist, Optometrist, Physical Therapist, Registered Nurse, Speech Pathologist

Packet Literature (PDF, 476 KB)

Allied provider agreement (PDF, 541 KB) and appropriate record application as outlined below.

If your specialty is not listed

Please contact Provider Information & Enrollment at (800) 258-3091 for contracting information.

Requirements

Read about what we require from our physicians and other healthcare professionals in our Blue Shield Provider Networks.

Processing and participation

Blue Shield will assign the effective date for your participating status based upon the receipt of all required documentation and completion of the credentialing and contracting processes.

A copy of the executed agreement including the assigned effective date will be returned to you after processing. Please contact Provider Information & Enrollment with any questions at (800) 258-3091.

Please note: the application process is split into two different actions: contracting and credentialing.

Contracting

Please send all documentation related to the contracting portion of this documentation by one of the following:

Fax: (916) 350-8860

Email: BSCproviderinfo@blueshieldca.com

Blue Shield of California
      Attn: Provider Information & Enrollment
      P.O. Box 629017
      El Dorado Hills, CA 95762-9010

Credentialing

Please send your completed credentialing application and all required documents to the Credentialing Department via either email or mail to:

Email: BSCInitialApp@blueshieldca.com

   Blue Shield of California
Attn: Credentialing Department
601 12th Street, 21st Floor
Oakland, CA 94607