Provider Forms & Resources

We provide a complete toolkit of resources for your use – from provider change forms and electronic data interchange forms to claims submissions.

The Provider Resource Center provides access to some forms for accessing electronically.

Forms and Resources

About Case Management and Care Coordination

When you as the provider and Blue Cross and Blue Shield of Vermont as the plan work together to help coordinate the care of our members, there are times when we may need to use members' Protected Health Information (PHI). Under these circumstances, the members do not need to provide authorization for this use of their PHI.

Blue Cross VT is committed to respecting the privacy of our members' PHI. As a Covered Entity under HIPAA, we do not use or disclose a member's PHI unless either HIPAA's Privacy Rule permits or requires such disclosure, or the member who is the subject of the PHI authorizes such use or disclosure in writing. The Privacy Rule specifically permits the use and disclosure of a member's PHI for the purpose of that member's case management and care coordination. This permitted use allows us to work together with providers in a safe way to help facilitate a member's case management and care coordination needs. (See 45 CFR §§ 164.501, 164.502(a)(1); see also and

How to Refer to Case Management

There are three options to refer to case management and either the member or provider can initiate:

  1. Complete the following form on our website:
  2. Send our team a secure email at
    • ​​​​​​​At a minimum, the email will need to contain the member name, date of birth and phone number where they can be reached.
    • Emails should always be sent through a secure method.
  3. Call (800) 922-8778, option 3.

Laboratory Services

Mental Health and Substance Use Disorder (MHSUD) – Additional Resources

  • Valera Health provides virtual care for members, and in addition to treating conditions ranging from depression to schizophrenia, they also treat children and adolescents staring at six years of age, maternal health, and serious mental illness.
  • For members with access to Amwell, Blue Cross VT's 24/7 telemedicine partner, Amwell therapists treat a wide range of MHSUD diagnoses.

Find out how to refer members either to a Valera provider or to Amwell.

Provider Orientation

Provider Change Forms

Group Practice or Solo/Individual/Independent Provider Demographic Change Forms

To make changes to an address, NPI, tax identification number, or a group name, complete the following:

To make a change to a provider name, complete the following:

Mental health and substance abuse clinicians need to complete the Area of Expertise form to identify their area of expertise for marketing in the Blue national directories.

Quick Links

Access additional resources and tools for providers

Contact Us

Have Questions or Need Assistance?

Connect with our team - we are here to help!