e-Referral - Forms

Sign Up for e-referral

Listed below are links to the required forms for signing up and using e-referral. Besides the e-referral Application form, there are forms for provider offices and billing services that wish to make a change in the information they previously provided to Blue Care Network.

If you need help in completing either the e-referral Application or the e-referral Request for Group ID Changes form, there is a link below to detailed instructions.

Standard e-referral forms:

e-referral Application form – Sign up for e-referral (PDF)
Change form – Add or delete providers or users (PDF)
Change form for billing services and service bureaus – Request group ID changes (PDF)

Instructions:

How to complete the application and change forms (PDF)

e-referral Resources

Care Management Resources

Additional Resources

Sign Up for e-referral