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Thank you for registering with Blue Cross of Idaho

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

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

Contracting Physician Service Extender

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




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