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Forms

Looking for an easier way to organize all of the Blue Cross & Blue Shield of Rhode Island (BCBSRI) forms you use on a regular basis? The most commonly used forms are available below, including the Application Request and Practitioner Change Forms. Some forms can be submitted online, and others can be printed and then faxed or mailed to us. (There are specific instructions on each form.)

What do you need to do?

Online Forms

• Provider Application Request Form
• Web Site Registration Instructions for Physicians/Providers
• Web Site Registration Instructions for Institutions/Facilities

Downloadable Forms

Downloadable forms can be accessed here.

Patient Coordination of Benefit

To process claims timely and accurately, it's important that we know if a patient has any health insurance coverage other than Blue Cross & Blue Shield of Rhode Island. If your patient has other coverage, please complete this form. You can fax it to (401) 459-1137 or mail it to:

Attn: Provider COB – 00043
Blue Cross & Blue Shield of Rhode Island
500 Exchange Street
Providence, RI 02903

Please note: In addition to completing the form, you can attach a photocopy of the front and back of the other health insurance card. This will help improve processing of the form.