To Request A Provider Number ONLY (does not include network participation)
Please complete the Health Delivery Organization (HDO) Information Form 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.
One of the following attachments is required based on the facility type:
You may fax, e-mail or mail your HDO Form and supporting documents to BCBSLA using the following information:
The BCBSLA Network Operations Department only provides application status updates to the facility 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 Facility Network Participation page.
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