Provider Forms

A big part of helping patients succeed in taking ownership of their health is their relationship with you as their healthcare provider. Our Healthy You! benefit helps our members work with you to find their health status and learn what lifestyle changes they need to make and what other treatment they may need.

To help you file claims regarding Healthy You!, we've published a library of Healthy You! procedure and diagnosis codes. Click here to download the Healthy You! codes. You also can learn more about the Healthy You! benefit.

Because electronic filing of claims is so important to provide efficient service to you and your patients, we have included Electronic Claims Filing documents on our Electronic Solutions page. Please review these documents to learn about setting up electronic submission, resolving common errors and claim reject reasons.

To inform us about changes in provider information, download the applicable editable PDF form below:

Provider Administration Update Form - Professional

Provider Administration Update Form - Institutional Ancillary

Out of Area and Non-Network Provider Prior Authorization Process Links

The links below will take you directly to the Online Prior Authorization submission process.

If you are a Mississippi Network Provider, you should submit your Prior Authorization requests through our secure myBlue Provider website.

Submit an Outpatient and Professional Services Authorization Request

Submit a Mental Health and Substance Abuse Prior Approval Form

Submit a Prescription Drug Prior Authorization Request. 

Submit a Prescription Drug Benefit Appeal Form

Submit a Home Infusion Therapy Request Form

Submit a Home Health & Hospice Authorization Request Form

Submit an Inpatient Precertification Request Form

Submit Continued Stay and Discharge Request Form

Submit a Transplant Prior Authorization Request

Forms to Download (PDF format)

The forms below are all PDF documents. Simply click on the form name to open them.

Care-Related

Durable Medical Equipment Certification Form

Medical Transport Prior Approval Request

Administrative

Non-Network Provider Written Direction of Payment Form

Provider Correspondence Form

Modifier Usage Guidelines

Coordination of Benefits Questionnaire

Provider Remote System Access Agreement

BCBSMS Electronic Submission of Claims Agreement

Pharmacy System Access Agreement