September 2019

The Provider Onboarding Form and User Guide

Blue Cross and Blue Shield of Illinois (BCBSIL) welcomes you to apply and join our provider networks. We want to help make the application process as efficient as possible. Our new Provider Onboarding Form is designed to help streamline the application process.

Tips for Using the Provider Onboarding Form

For best results, use the Google Chrome browser. Individual and Medical Groups/Clinics that want to apply to join our networks should fill out the online Provider Onboarding Form. For more information on completing the form, refer to the Provider Onboarding Form User Guide.
On the first step: Select Participation, be certain to have all information listed in the blue box on the left side of the screen before getting started. On the right side of the screen, the fields represent the contact information of the person completing the form on behalf of the provider (office manager, biller, etc.).
Be sure to know your billing (type 2 organizational) National Provider Identifier (NPI) as listed in the NPI Registry.
If you are a New Group or an Existing Group adding additional providers, on step two: Enter Your Information, pay special attention to the “Provider Roster Instructions” box on the right side of the screen. Proceed to download and complete only the roster provided by BCBSIL.
You must submit the roster as an Excel file. If the appropriate roster is not used, your information will be rejected. You must complete all the data elements on the roster. The second tab of the roster Excel sheet serves as an example of the Standardized Template Grid.

Check the Status of Your Form
After you complete the onboarding form, you will receive an email from us with a unique case number. To check the status, enter the case number in our Case Status Checker.

Need help? Training coming soon!
We are hosting training sessions to help you complete our Provider Onboarding Form on the following dates:

The training will include:

New Group/Provider Contracting
Requesting the Addition of a Provider to your Group
How to submit Demographic Changes

You may also register by visiting the Webinars and Workshops section of our Provider website.

bcbsil.com/provider

Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association