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Get bcbs referral form 2010-2024

Al method and then fax this completed form explaining the circumstances to 1-800-303-8930 or 205 220-5763 To enter a referral through the VRU, please call 1-888-881-1416. For assistance in entering the referral, call Customer Service at 1-877-231-7239. Primary Care Physician Information Physician Name Middle Initial Last Name Individual NPI Unique Provider Identification Number (UPIN) Office Contact (National Provider Identifier) Hospital/Clinic Address City State Office Telephone Zip.

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