Becoming a BCBSAZ network provider starts with the contract request and credentialing process. In order for us to process your request, please confirm that the following steps have been completed.
Have you registered with CAQH?*
Have you completed all the necessary steps below to enable BCBSAZ to access and review your universal CAQH application? *
Contact information for questions related to this application:
Please note: State law requires PA and PAC providers to have a supervising physician on file. Please provider a supervising physician name and degree.
Supervising Physician Information
Do you have an active DEA Registration Number?
What are your practicing specialties?
Are you participating as a PCP under the above tax ID? *
This participation impacts accuracy of cost share for services provided.
Are you Medication-assisted Treatment (MAT) Certified? *
Are you accepting new patients? *
This information will be noted in our provider directory.
Are you an Indian health service provider with the federal health program for American Indians and Alaska Natives? *
Are you interested in participating in our Medicare Advantage network? *
Do you (physician, not the staff) speak any languages other than English?
This request applies to (check one or both):*
Hospital/Freestanding Surgery Facility Privileges
Does your group have a concierge practice? *
Contact person for the practice (practice administrator/office manager) for business correspondence:
Contracts and correspondence must be sent to the provider, not a billing company or a consultant.
Primary Office Information
Primary address must be a physical location in Arizona, where services are performed.
Select the days and hours that your primary office is open:
All Other Addresses
Medical Records Address:
Additional Office Information
Do you have another location where you actively practice on a regular basis, under the same Tax ID?
Select the days and hours that your secondary office is open:
Attach Supporting Documents