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Blue Cross Solo Physician Assistant Contracting Application

Important information

Please complete this form if you meet the following criteria:

  • New to Blue Cross*, and
  • Bill under a Social Security Number or an Employer tax ID (EIN) as a sole proprietor, and
  • Do not currently reimburse any clinicians for services.

If any of these do not describe you, please select the non-Solo application instead or submit a Contract Update Form for Physician Assistants and Ancillary Advanced Practice Nurses. This form is on Go to Forms>Contract Updates.

Application process

Blue Cross will evaluate this application according to your ability to meet pre-established credentialing criteria and network need, as determined solely by Blue Cross.

We reserve the unqualified right to reject any and all applications, subject to the terms of this application and applicable law.

By accepting this application for evaluation, we agree that any patient-specific or identifying information, any non-publicly available information that you designate as confidential set forth in this application, and any non-publicly available information that is obtained in the application process will remain confidential unless its release is required or permitted by law, regulation, or valid court order.

*Blue Cross refers to Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross and Blue Shield of Massachusetts HMO Blue®, Inc., and/or Massachusetts Benefit Administrators LLC, based on Product participation.