Provider Enrollment Assistance Form

Provider Enrollment Assistance Form

Use this form to contact us regarding enrollment applications that were submitted through our historical process.

For applications submitted through My Provider Enrollment Portal, please use case comments or the support feature.

Note: Use Microsoft Edge or Google Chrome to access the portal.

To see which forms are needed for provider enrollment, please see the individual checklistgroup checklist or in state, out of network checklist.

If you're checking on the status of an application, please note we will contact you at these points in the application process:

  1. When we receive your entire application 
  2. If we need any additional documentation 
  3. When your application is moving to the onboarding process 
  4. When your enrollment is complete and you are enrolled with BlueCross BlueShield of South Carolina and BlueChoice HealthPlan

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.