- Application For Clinic/Group/Institution/Location to File Claims or to Change Employer Identification Number (EIN)
- Authorization to Bill
- Change of Address
- Clinical Laboratory Amendment (CLIA) Certification Verification Form
- DBA Name Change
- Dental Credentialing Application – Non-medical dental providers (DDS) can apply for network enrollment using this form
- EFT Application and Terms and Conditions
- Health Professional Application - For out-of-network providers only
- Healthy BlueSM Credentialing Questionnaire - For enrolling and credentialing with Healthy Blue.
- Nurse Practitioner Information Form
- NPI Update Form
- Provider Enrollment Application – New physicians and other health care professionals who want to join our networks can apply using this form.
- Registration Form for Mid-level and Hospital-Based Providers – For mid-level and hospital-based providers who want to join non-Medicaid networks. Do not use this form if you are also applying for the Healthy BlueSM (Medicaid) network. Use the Provider Enrollment Application.
- Request to Add or Terminate Provider Form
- Satellite Location Application
- Virtual Care Services Application – Complete this form for your practice to apply for participation with telemedicine and/or telehealth services. Email the completed application with supporting documentation to VIRTUALCARE@bcbssc.com.
BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.