![]() ![]() Providers can select the question mark icon where available if they need assistance with those fields. Providers who want to be in-network will have additional fields to complete on the form. ![]() When filling out the Provider Onboarding form, use Google Chrome for best results. Physicians, Professional Providers and Hospital/Facility Based Providers A new request will need to be submitted to reinstate it. Termination of Unused Provider Record ID: Please Note: BCBSTX may automatically cancel a Provider Record ID that does not have any claim dates of service within a 12-month time period. Note: Use the Demographic Change Form, if you already have a BCBSTX Provider Record ID and only need to update your demographics (i.e., address, phone, specialty).īefore you can join the BCBSTX Provider Networks or send claims electronically as an out-of-network provider, you will need to be assigned a BCBSTX Provider Record ID.
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