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Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

Contracting Physician Service Extender
(PA, CSA, CST, COT, CRNFA, OPA-C)

To be a contracting provider, the service extender must be employed and supervised by a licensed provider.

 Submit the following items. Any missing items may result in the return of incomplete documents or a delay in processing.

  • Current state license (attach a copy)
  • Malpractice/liability insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
  • Provider information sheet
  • W-9

 

Return to:

Fax:  208-387-6818

Email:  PR2PI@bcidaho.com