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Use the forms below to "get on file" to process claims or to provide us with updated information. Please fax the completed forms to 803-264-4795. We will receive the information in a secure electronic inbox. If you have any questions about the forms, please e-mail us at provider.cert@bcbssc.com.

You can fill out each form online. You may also save the forms to your computer. To complete your application, please print the form, sign and fax to the number on the form.

Get On File for Claims Processing

Use these forms to file claims for the following BlueCross BlueShield of South Carolina plans: Preferred Blue^®, State Health Plan, FEP and the Preferred Dental Network.

These forms are not applications to join any of the networks. They simply allow you to file claims to BlueCross. This is not a guarantee that we will pay the claims you file.

If you are interested in joining either our health plan or mental health networks, please see our credentialing and recredentialing section.

File Application Packet
Who should complete this packet? Healthcare professionals or entities who want to file claims to us or make changes in the information that we have on file about them. This packet contains:

• Health Professional Application
  Who should complete this form? Individual healthcare professionals who wish to file claims to us, regardless of whether or not you wish to participate in our networks.
• Clinic/Group/Institution/Location Application
  Who should complete this form? Clinics, partnerships, professional associations, institutions and other groups who wish to file claims to us.
• Authorization for Clinic/Group to Bill
  Who should complete this form? Both network and non-network individual healthcare professionals who wish to assign benefit payment to a clinic, partnership, professional association or other group. Each individual in a group must complete this form.

Add or Change Provider Information

Use these forms to notify us of any changes in demographic information or any additions/deletions of providers to your staff. We use this information for claims processing and in our directories.

Request to Add, Terminate or Change Practitioner Affiliation
Who should complete this form? Both network and non-network healthcare professionals who wish to request the addition or termination of a health professional's association with their clinic, group, professional association or institution, or to report if a practitioner is changing locations within your clinic, group, professional association or institution.

Request to Change Tax ID
Who should complete this form? Any network or non-network clinic, partnership, professional association, institution or other group that wants to let us know it is changing Tax ID numbers.

Change of Address Form
Who should complete this form? Any network or non-network providers who want to let us know they have changed locations or appointment phone numbers. You should also use this form to let us know you want to change the address to which we send payment for services.

Addition of Satellite Office
Who should complete this form? Any network or non-network providers who want to let us know they have added a new location.
 
National Provider Identifier Notification Form
Who should complete this form? Any network or non-network providers who need to register their National Provider Identifier (NPI) with BlueCross BlueShield of South Carolina. 

For more information on NPI, go to the HIPAA Critical Center.