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You can request contracting or credentialing by completing and sending us the appropriate form (see options below). Also use these forms to add a tax ID to your contract. To update other provider information, please use the Provider Information Change Form (login and go to “Provider Resources > Forms > Provider Information Change”). To add a line of business or request participation in another BCBSAZ network, contact your provider liaison.
Facilities, Professional Groups, and Ancillary Providers: Facility/Group/Ancillary form (also use this form to add a tax ID to your contract). If you are interested in being added to the TriWest Healthcare Alliance Network for veterans, please visit the TriWest contracting page to request a contract.
Medical Professionals: Medical Professional form (requires a CAQH Proview number and completed provider profile; also use this form to add a tax ID to your contract)
- If you are a PT/ST/OT professional and are part of a group, your group must have a group contract on file with us before we can complete your credentialing.
- Chiropractors must apply through American Specialty Health (ASH) at 1 (888) 511-2743.
- Providers with concierge practices must meet specific requirements and sign a Concierge Practice Contract Addendum.
- If you are interested in being added to the TriWest Healthcare Alliance Network for veterans, please visit the TriWest contracting page to request a contract.
Dental Professionals: Dental form (requires a CAQH Proview number and completed provider profile)
TriWest Healthcare Alliance Network (for Veterans): If you are interested in being added to the TriWest Healthcare Alliance Network for veterans, please visit the TriWest contracting page to request a contract. If you have a contract with TriWest and would like to be credentialed or update your contract, please complete the above facility or professional forms.
Note: For more information about the BCBSAZ contracting/credentialing process, check out the overview.
