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Before you start

Use this guide when Blue Cross and Blue Shield of Minnesota is a required Local / Host Plan for your practice or claim-service location. Its non-participating setup form establishes a record for out-of-network claims. It is not a request to leave an existing network contract. If registration is incomplete, claims can be delayed. Not sure which plan applies? First identify your required Local / Host Plan. Registration is separate from joining a network.

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Request a non-participating record

1

Download the setup form

Open Provider Demographic Updates, find Non-participating setup request form, and download the linked form. Prepare a current W-9.
2

Choose the request that matches your practice

Select the new non-participating setup option, or the additional-location option if your non-participating group is already established.For professional claims, choose professional (837P). Do not choose institutional/facility (837I) just because several clinicians work in your group.
3

Complete the practice and location fields

Enter the legal and DBA names, specialty, tax information, requested effective date, and applicable NPI. Complete the physical, mailing, and pay-to addresses and the requester’s contact information.Answer the prior-contracting questions accurately. If you need to link individual clinicians and the form does not explain how, ask Provider Data for the affiliation process.
4

Send the form and W-9

Email both to Provider.Data@bluecrossmn.com, or use the postal destination on the official page. Keep a copy and request confirmation of active registration.

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Timing and existing records

Blue Cross Minnesota says to allow up to 90 days for this process. The payer controls the actual completion date. Use the current linked setup form. The separate EFT section on the demographic page is not an alternative registration route for a non-contracted practice. For other record changes, ask Provider Data which process to use.

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What happens next

Once each required plan confirms registration and the required clinician associations are active, notify Thrizer support and review what happens next. The payer controls registration and claim decisions. Registration does not guarantee reimbursement or recognition of every clinician category. For associate, pre-licensed, or supervised clinicians, ask the payer about recognition and review Thrizer’s supported claim structure.