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Welcome

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Providers

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iEXCHANGE^® Registration Form

Note: Provider includes Physician, Professional Provider and Facility Provider

An asterisk (*) indicates a required field.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
© Copyright 2012. Health Care Service Corporation. All Rights Reserved.

Important Information about Blue MedicareRx^SM

^SM Service Mark of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

^® Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Blue Cross and Blue Shield of Oklahoma refers to HCSC Insurance Services Company, which is a wholly owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company. These companies are independent licensees of the Blue Cross and Blue Shield Association and offer or provide services for stand-alone prescription drug plans with a Medicare contract under contract number S5715 with the Centers for Medicare and Medicaid Services.

A stand-alone prescription drug plan with a Medicare contract.

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* National Provider Identifier (NPI) Number:
* Provider Name:
* Primary Specialty:
* Address:
* City/State/Zip Code:	//
* Provider Office Phone Number:
* Contact Name:
* Contact Phone Number:
* Contact Fax:
* Contact E-mail:
* Name of Person Who Will be the Assigned Group Administrator of Your Account:
* Group Administrator's Email Address:
* Is Your Office a Current iEXCHANGE Web User for Another Health Plan?	Yes No
Reset	Submit
Note: The iEXCHANGE Support Desk will email your Group Administrator your iEXCHANGE ID, user ID and temporary password. Please allow five business days for processing.

iEXCHANGE® Registration Form

iEXCHANGE^® Registration Form