Electronic Medicare Provider/Supplier
Enrollment Forms
The Center for Medicare & Medicaid Services (CMS) has made
available electronic Medicare Provider/Supplier Enrollment
forms on its website. These forms can be immediately accessed
at http://www.cms.hhs.gov/MedicareProviderSupEnroll. In addition to the forms, you can download a comprehensive
and a quick reference user's guide for your assistance. The
forms can be completed, saved and printed for submission using
your computer. However, please be aware that they cannot be
submitted electronically because an original signature is required.
Questions and Concerns with Enrollment
CMS has developed a MedLearn article with information
and education resources to meet physician and other provider’s
business needs. You may review the article by selecting this
link: Information and Education Resources for Medicare Providers,
Suppliers, and Physicians.
CMS provides an excellent source for current information regarding the enrollment process at http://www.cms.hhs.gov/MedicareProviderSupEnroll.
If you prefer to talk with one of our representatives, please contact Sharon Hudson, Enrollment Coordinator at (602) 864-4225 with any enrollment questions you may have or you may call toll-free to the Customer Service line at 1.877.567.3128.
Completed forms should be mailed to:
Regular Mail
Blue Cross of Arizona
P.O. Box 37700
Phoenix, AZ 85069 |
Overnight
Blue Cross of Arizona
2331 W. Royal Palm Road, Suite 115
Phoenix, AZ 85021 |
In addition, we develop a newsletter for the provider
community that contains program and billing information, news
items, and reminders. It is published monthly. It is available
at http://www.medicareaz.bcbsaz.com/providers/newsletters/index.asp .
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