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

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Provider Information Sheet / W9 Form

A Provider Information Sheet needs to be completed if either of the following apply:

  • Existing Blue Cross of Idaho provider adds a new location , or
  • Existing Blue Cross of Idaho provider leaves one location and moves to another location.

It is very important that you include all of the information requested on the Provider Information Sheet. Once completed, please return the form to Blue Cross of Idaho.

W9 Form
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