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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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Acupuncturist

Acupuncturist Contracting Application

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

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

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Ambulatory Surgi-Center

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Ancillary Institutional Providers

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

Provider Application

Before you enter the Provider Application, complete and save the required form for your provider type.

Ancillary Institutional Providers:
  • Ambulance1
  • Assisted Reproductive Technology1
  • Behavioral Health Hospital2
  • Chronic/Long Term Care Hospital1
  • Community Mental Health Center2
  • Durable Medical Equipment1
  • Home Health Care1
  • Hospice1
  • Radiation Oncology Facility1
  • Skilled Nursing Facility1
  • Transitional Care Unit1
  • Ambulatory Surgi-Center1
  • Behavioral Health Facility2
  • Cardiac Rehabilitation1
  • Clinical Laboratory1
  • Dialysis1
  • Early Intervention1
  • Home Infusion Therapy1
  • Independent Physiological and Diagnostic Lab1
  • Rehabilitation Hospital1
  • Sleep Study Facility1
  • Urgent Care Center1

1. These provider types must upload the Additional Site of Service form as an attachment when they fill out the Provider Application.

2. These provider types must upload the Behavioral Health for Children and Adolescents (BHCA) form as an attachment when they fill out the Provider Application. They must include all their Massachusetts-licensed sites as well as the sites used for home-based BHCA services.

Be sure to click the "Yes" button on the final screen to submit your application:

Assisted Reproductive Technology

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

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

Before you begin, complete and save the Behavioral Health for Children and Adolescents form. You will need to upload the form as an attachment when you fill out the Provider Application. You must include all your Massachusetts licensed sites as well as your sites used for home-based BHCA services.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Behavioral Health Hospital

Before you begin, complete and save the Behavioral Health for Children and Adolescents form. You will need to upload the form as an attachment when you fill out the Provider Application. You must include all your Massachusetts licensed sites as well as your sites used for home-based BHCA services.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Birth Center

Birth Center Contracting Application

Fax this form with the requested documentation to 1-617-246-6819 or email to BlueCrossNetworkContracting@bcbsma.com.

Cardiac Rehabilitation

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:


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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

Child Psychiatrist

Contracting Application

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

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Clinical Laboratory

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Clinical Psychologist

Contracting Application

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

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

Community Mental Health Center

Before you begin, complete and save the Behavioral Health for Children and Adolescents form. You will need to upload the form as an attachment when you fill out the Provider Application. You must include all your Massachusetts licensed sites as well as your sites used for home-based BHCA services.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Dentist

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

Dialysis

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Durable Medical Equipment

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Early Intervention

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Home Health Care

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

Home Infusion Therapy

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Hospice

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

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

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Licensed Alcohol and Drug Counselor

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

Licensed Applied Behavior Analyst

Licensed Applied Behavior Analyst Contracting Application

Please fax your completed form to us at 1-617-246-5053.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

The following table explains how Nurse Practitioners and Physician Assistants contract with us.

If you: Then you can contract as an/a:
Render primary care Have a collaborating or supervising physician who is listed with Blue Cross as a primary care physician Maintain a panel of patients and manage their care Render specialty care

Yes

Yes

Yes

No

NP-PCP (or PA-PCP)

Yes

Yes

No

No

NP-primary care
(or PA-primary care)

No

No

No

Yes

NP-specialty care
(or PA-specialty care)

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

The following table explains how Nurse Practitioners and Physician Assistants contract with us.

If you: Then you can contract as an/a:
Render primary care Have a collaborating or supervising physician who is listed with Blue Cross as a primary care physician Maintain a panel of patients and manage their care Render specialty care

Yes

Yes

Yes

No

NP-PCP (or PA-PCP)

Yes

Yes

No

No

NP-primary care
(or PA-primary care)

No

No

No

Yes

NP-specialty care
(or PA-specialty care)

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

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.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

Physician Assistant

Physician Assistant Contracting Application

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

The following table explains how Nurse Practitioners and Physician Assistants contract with us.

If you: Then you can contract as an/a:
Render primary care Have a collaborating or supervising physician who is listed with Blue Cross as a primary care physician Maintain a panel of patients and manage their care Render specialty care

Yes

Yes

Yes

No

NP-PCP (or PA-PCP)

Yes

Yes

No

No

NP-primary care
(or PA-primary care)

No

No

No

Yes

NP-specialty care
(or PA-specialty care)

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

The following table explains how Nurse Practitioners and Physician Assistants contract with us.

If you: Then you can contract as an/a:
Render primary care Have a collaborating or supervising physician who is listed with Blue Cross as a primary care physician Maintain a panel of patients and manage their care Render specialty care

Yes

Yes

Yes

No

NP-PCP (or PA-PCP)

Yes

Yes

No

No

NP-primary care
(or PA-primary care)

No

No

No

Yes

NP-specialty care
(or PA-specialty care)

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Multi-specialty groups:  You must apply for a separate group agreement for each specialty:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives
  • Psychiatrists and other licensed behavioral health clinicians

In addition, every practice member must submit a request to join the applicable group contract.

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.

Radiation Oncology Facility

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Rehabilitation Hospital

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Skilled Nursing Facility

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Sleep Study Facility

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

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

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

 

Urgent Care Center

 Before you begin, complete and save the Additional Site of Service form. You will need to upload the form as an attachment when you fill out the Provider Application.

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

Provider Application

Be sure to click the "Yes" button on the final screen to submit your application:

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.