Provider Information for Authorizations

This form has moved to our provider portal. Please click here to get redirected to the new form. 

Please note: 



For updates to in-network/participating providers with Michigan, Louisiana, Kansas, Arkansas & Walmart:   

·         If you're speaking with the provider, please instruct them to update their               information directly with the plan, either via the plan website or contacting           their plan provider representative as appropriate.

·         If you’re speaking with a member, please report using Datix.  

 

For updates to in-network/participating providers contracted with Lucet for Blues plans (Alabama, Florida, Kansas City, and Arkansas FEP) please log into the Lucet Provider Portal:

·         Use the Provider Profile Update Forms based on your provider type: 

Individual practitioners go here

Facility providers go here


For updates and adds for out-of-network/non-participating providers, please continue use of this form.

Facility Group Information
Individual Information
Service Address