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Contracting Applications

If you would like to contract with Blue Cross Blue Shield of Massachusetts, complete the appropriate contracting application. Make sure you meet our credentialing guidelines.

Check the status of your application
If you’ve already applied to join our networks and want to learn the status of your application, email us at Providerapplicationstatus@bcbsma.com.

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Alternative Therapy Providers

Blue Cross Blue Shield of Massachusetts does not contract with or credential the alternative therapy practitioners listed below. However, our members can receive a 30% discount on alternative therapy providers who participate with WholeHealth Networks, Inc., a Tivity Health company.

For more information on becoming an in-network practitioner with WholeHealth Networks, Inc., a Tivity Health company please call their practitioner recruitment department at 1-800-274-7526. Or, visit their website.
 

  • Acupuncture
  • Personal Training
  • Massage Therapy
  • Pilates
  • Mind/Body Therapy
  • Qi (chi) gong
  • Naturopathic Medicine
  • Tai Chi
  • Nutritional Counseling
  • Yoga

Ambulance

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

 

Ambulatory Surgi-Center

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Ancillary Institutional Providers

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Ancillary Institutional Providers:
  • Ambulance
  • Ambulatory Surgi-Center
  • Assisted Reproductive Technology
  • Behavioral Health Facility
  • Behavioral Health Hospital
  • Cardiac Rehabilitation
  • Chronic/Long Term Care Hospital
  • Clinical Laboratory
  • Community Mental Health Center
  • Dialysis
  • Durable Medical Equipment
  • Early Intervention
  • Home Health Care
  • Home Infusion Therapy
  • Hospice
  • Independent Physiological and Diagnostic Lab
  • Radiation Oncology Facility
  • Rehabilitation Hospital
  • Skilled Nursing Facility
  • Sleep Study Facility
  • Transitional Care Unit
  • Urgent Care Center

Assisted Reproductive Technology

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Audiologist

Audiologist Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Behavioral Health Facility

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Behavioral Health Hospital

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Cardiac Rehabilitation

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Certified Nurse Midwife

Certified Nurse Midwife Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-4227.

Child Psychiatrist

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

 

Chiropractor

Chiropractor Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053. You cannot save the information contained in the form.

Diagnostic imaging services

If you Then
Have professional privileges No new professional privileging application is required.
Have technical privileges but are moving, adding a site, or joining a new practice You must submit a Limited Technical Privileging Application for your new location.
Are not currently approved for either professional or technical privileging Go to the Privileging page and download the applicable privileging application.

Chronic/Long Term Care Hospital

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Clinical Laboratory

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Clinical Psychologist

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Clinical Specialist in Psychiatric and Mental Health Nursing

Clinical Specialist in Psychiatric and Mental Health Nursing Contracting Application
 

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.
 

Community Mental Health Center

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Dentist

To enroll with us, please call Dental Network Management at 1-800-882-1178, Option 4. Or e-mail us.

A Guide to the Dental Professional and Oral Surgery Agreement

Dental Blue Fact Sheet

Dental Blue PPO Fact Sheet

Dialysis

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Durable Medical Equipment

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Early Intervention

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Home Health Care

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Home Infusion Therapy

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Hospice

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Hospital-based Physicians (Emergency Medicine, Radiology, Anesthesiology, Pathology, and Nuclear Medicine)

Hospital-based physicians (including Emergency Medicine, Radiologists, Anesthesiologists, Pathologists, and Nuclear Medicine) may contract with us without going through the credentialing process if they do not bill independently under separate tax identification number.

  • The practitioner must submit a completed IMA (Integrated Mass Application).
  • The hospital must provide a letter confirming that the physician has been credentialed in accordance with 243 CMR 3.05. The letter must be addressed to Blue Cross and:
    • Be less than one year old
    • Describe any pending or closed healthcare facility or public agency disciplinary actions against the physician
    • State that the physician’s privileges have not been altered due to direct or indirect concerns about his or her professional performance, judgment, or clinical skills.

Providers who have been enrolled as a non-credentialed hospital-based provider but who want to practice outside of the Emergency Room must become fully credentialed.  

Independent Physiologic & Diagnostic Laboratory

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Licensed Alcohol and Drug Counselor

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Licensed Dietitian Nutritionist

Licensed Dietitian Nutritionist Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

Licensed Independent Clinical Social Worker

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

Licensed Marriage and Family Therapist

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

Licensed Mental Health Counselor

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

Nurse Practitioner

Nurse Practitioner Contracting Application 

You may fill out the contracting application online; however, you must print and fax it to 617-246-4227.

Nurse Practitioner - Psychiatric Nurse Practitioner

Psychiatric Nurse Practitioner Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

 

Nurse Practitioner Primary Care Provider

Nurse Practitioner Primary Care Provider Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-4227.

Occupational Therapist

Occupational Therapist Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Opioid Treatment Program

Opioid Treatment Program Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-6819

Optometrist

Optometrist Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Diagnostic imaging services

If you Then
Have professional privileges No new professional privileging application is required.
Have technical privileges but are moving, adding a site, or joining a new practice You must submit a Limited Technical Privileging Application for your new location.
Are not currently approved for either professional or technical privileging Go to the Privileging page and download the applicable privileging application.

Physical Therapist

Physical Therapist Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Physician

HCAS Provider Enrollment Form

Please fax your completed form to us at 617-246-4227.

We privilege providers who perform diagnostic imaging services.  To learn how to apply to provide professional or technical services, go to our Privileging page.

Physician Assistant

Getting started
Please complete your online application using the online contracting link below. Here’s what you need to know to get started:

  • Make sure you meet the Credentialing Guidelines for your provider type.
  • Fill out the online application (see link below) and click Submit. You can save your work and finish later, if necessary.
  • Print out the completed application.
  • Obtain signatures and gather supporting documentation.
  • Fax the application to us.

If your contracting application is approved, we’ll send you contracts for your signature.

Online contracting application

Information to have ready to complete your contracting application
Have this information ready before getting started:

  • Address, phone, fax, and email address of each practice location where you'll provide services (identify primary and secondary)
  • Tax ID numbers for clinician and group practice
  • National Provider Identifiers (NPIs) for clinician and group practice
  • Medicare numbers (if applicable) for clinician and group practice
  • Massachusetts license number
  • For clinicians:  Information on other clinicians and practices that provide coverage for you, including names, NPIs, Medicare PTANs (if applicable), and whether they are primary or secondary with this practice
  • For group contracts:  practice members in the specialty, including their names, NPIs, Medicare PTANs (if applicable), and whether they are primary or secondary with this group
  • Information about your collaborating or supervising physician.

 

Physician Assistant Primary Care Provider (provider panel)

Physician Assistant Primary Care Provider Contracting Application

Please print and fax the contracting application to us at 617-246-4227

Physician Assistant Primary Care Provider Fact Sheet - includes administrative requirements for PA-PCPs.

 

Physician Groups and Incorporated Physicians

Physician Group Application

Please fax your completed application to us at 617-246-4227.

We privilege providers who perform diagnostic imaging services.  To learn how to apply to provide professional or technical services, go to our Privileging page.

Podiatrist

Podiatrist Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053

Diagnostic imaging services

If you Then
Have professional privileges No new professional privileging application is required.
Have technical privileges but are moving, adding a site, or joining a new practice You must submit a Limited Technical Privileging Application for your new location.
Are not currently approved for either professional or technical privileging Go to the Privileging page and download the applicable privileging application.

Psychiatrist

Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

Diagnostic imaging services

If you Then
Have professional privileges No new professional privileging application is required.
Have technical privileges but are moving, adding a site, or joining a new practice You must submit a TDI Privileging Application for your new location.
Are not currently approved for either professional or technical privileging Go to the Privileging page and download the applicable privileging application.

Radiation Oncology Facility

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Rehabilitation Hospital

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Skilled Nursing Facility

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Sleep Study Facility

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Speech Language Pathologist

Speech Language Pathologist Contracting Application

You may fill out the contracting application online; however, you must print and fax it to 617-246-5053.

Technical Diagnostic Imaging

Please complete the TDI Privileging Application.

You may fill out the form online; however, you must print and fax it to 617-246-6819

Transitional Care Unit

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Urgent Care Center

Provider Application

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Important notes:

  • Complete the application using Internet Explorer 7, 8, 9, or Firefox. You may not be able to submit the application if you use another browser.
  • Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

Diagnostic imaging services

If you Then
Have professional privileges No new professional privileging application is required.
Have technical privileges but are moving, adding a site, or joining a new practice You must submit a Limited Technical Privileging Application for your new location.
Are not currently approved for either professional or technical privileging Go to the Privileging page and download the applicable privileging application.

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Web Content Viewer (JSR 286)