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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 Independent Registered Dietician

  1. Contact your Provider Relations Representative to order your contract. (See PAP100)
  2. 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)
    • Evidence of accreditation:  must be credentialed by the Commission on Dietetic Registration of the American Dietetic Association (CDRADA)
    • Malpractice/liability insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
    • Provider information sheet 
    • W-9
    • Credentialing application
    • Attachment A
    • Provider tax ID or ownership update (This is only required when a new contract on an existing provider is required due to a tax ID or ownership updated.)

 

 

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Fax:  208-387-6818

Email:  PR2PI@bcidaho.com