Credentialing

For Professional Providers
To Request a Provider Number ONLY (does not include network participation)

Please complete all applicable sections of the Louisiana Standardized Credentialing Application and attach a copy of the required supporting documentation listed below.  Signature and date must be original.  Signature stamps or date stamps are not acceptable.

  • General Information (page 1)
  • Primary/Secondary Location (pages 1-3) - Complete as many sections up to Fourth Practice Location as needed.
  • Specialty (page 5)
  • Professional Licenses (page 8)
  • General Questions (page 9)
  • Provider Statement to Release Information (page 10)

Required Supporting Documentation

  • Current, Unrestricted Professional State License
  • Employer Identification Number (EIN) Letter
  • Electronic Funds Transfer (EFT) application and a copy of a preprinted voided check. See our EFT page.
  • iLinkBLUE and Business Associate Agreement appropriate for your practice. See our iLinkBLUE page.
  • W-9 Form

Submission
You may fax, e-mail or mail your application and supporting documents to BCBSLA using the following information:

  • Fax: 225.297.2750
  • E-mail: Network.Administration@bcbsla.com
  • Mail: Blue Cross Blue Shield of Louisiana
    Attn: Network Administration
    P.O. Box 98029
    Baton Rouge, LA  70898

The BCBSLA Network Operations Department only provides application status updates to the provider in question.  To check the status of an application or for additional information call 1.800.716.2299 option 3. 

If you are interested in joining our networks, please visit our Professional Provider Network Participation page.