For Facilities

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.

Provider Record Set-up Criteria

Facilities at minimum must meet the criteria listed below:
  • Valid license, as applicable to type of facility
  • Signed and dated attestation/release to obtain primary source verification for the organization

Required Supporting Documentation

  • Valid state license, as applicable
  • Occupational or Operational license, as applicable
  • CLIA certificate, as applicable
  • 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

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:
  • Fax: 225.297.2750
  • E-mail:
  • 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 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.