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Questions or need help? Contact provider service at (800) 924-3494.
|BlueCard Appeal Form||To appeal a confirmed denial of benefits|
|CMS 1500||To file a claim|
|CMS 1500 Version 02/12||2013 version of form to submit professional claims|
|CMS 1500 Billing Instructions||CMS 1500 paper claim billing instructions|
|COB Questionnaire for BlueCard Members||To file COB info on BlueCard members.|
|Coordination of Benefits Questionnaire||When a patient is covered by more than one health plan|
|Payment Inquiry Form||To inquire about a payment/claim|
|Prior Approval||To view services and supplies that require prior approval|
|Provider Overpayment Form||When you detect an overpayment|
|Area of Expertise Form||Mental health and substance abuse clinicians must use this form to identify their area of expertise for marketing in both the on line and paper directories|
|CAQH Application for Credentialing||Paper application for providers who don't want to file electronically|
|Facility Credentialing||Defines the requirements for facilities|
Mental Health Counselor Trainee
Note: To qualify you must meet the requirements of the Mental Health Counselor Training Criteria policy located on the secure Provider Resource Center under BCBSVT Policies > Quality Improvement Policies > Mental Health Counselor Training Criteria.
|Provider Enrollment/Change Form (PECF)||
|Group Practice Enrollment/Change Form (GPECF)||
|Practitioner Credentialing Rights||Provider rights during credentialing process|
|W9||Used to report income to IRS|