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For Health Professionals

Join Our Network

Become part of the Capital BlueCross Provider Network

In order to receive payments from Capital BlueCross for the services you provide to our members, you must have a Capital BlueCross issued provider number, you must be credentialed and you must have an executed contract with us. If you do not meet these qualifications and you provide services to a Capital BlueCross member, payment will be made to the subscriber.

*If you are a Behavioral Health Provider interested in joining our Keystone Health Plan® Central, SeniorBlue® PPO or SeniorBlue® HMO networks, please contact Magellan Behavioral Health®, Inc. at 1.800.866.4108.

*If you are a Chiropractic Provider interested in joining our Capital BlueCross networks, please contact American Specialty Health Group, Inc.  at 1.800.972.4226.

To begin the process of joining our network of health care professionals or to have a Provider Relations Consultant contact you, please complete and submit the attachments below. 

Once we receive this form, we will provide you with a Council for Affordable Quality Healthcare (CAQH) ID number for you to access the CAQH database to finalize your application for participation and continue with the contracting process. If you are already listed with CAQH, this form will allow us to pull the necessary information to begin credentialing.

Complete the application for an individual or group practice.

Complete Taxpayer Identification Number (W-9) form and Electronic Fund Transfer (EFT) form.

Send completed application and Taxpayer Identification Number (W-9) form to CAIC Recruiters, CBC (CBC).

Additional Provider group Information

Required fields are noted with an asterisk *.

Primary Physician Information

Request Information