Out of State Providers

Out-of-State Providers

Out-of-State, Out-of-Network Providers

• NPI Provider Notification Form - Use this form to register your NPI. Note: This is for out-of-state providers. If you are located in South Carolina, additional forms may be needed/requested.

In-State, Out-of-Network Providers
This section contains forms needed to be added as a non-network provider.

• Application For Clinic/Group/Institution/Location to File Claims or to Change Employer Identification Number (EIN)
• Authorization to Bill
• Health Professional Application
• Electronic Funds Transfer (EFT) - Use these forms if you need to update/change or add EFT information to your existing group. Note: These forms are required to file claims with BlueCross BlueShield of South Carolina and BlueChoice HealthPlan.