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Blue Cross Physician Assistant Contracting Application

Important information

Please complete this form if you are:

  • New to Blue Cross* and joining a practice or facility that submits claims on a CMS-1500 or 837P

If this does not describe you, please select the Solo Practitioner application instead or submit a Contract Update Form for Physician Assistants and Ancillary Advanced Practice Nurses. This form is available 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.