Alabama Uniform Provider Application

The application was developed through a cooperative workgroup effort of Blue Cross and Blue Shield of Alabama, the Medical Association of the State of Alabama, the Medical Group Management Association, the Alabama Hospital Association, the Alabama Association of Medical Staff Services, the Alabama Medicaid Agency, and the Alabama Association of Health Plans.

Sign In
Social Security No:

Forget your password?

New User Registration

The Alabama Uniform Provider Application may be used for new providers who wish to be credentialed.

The application may be submitted electronically to Blue Cross and Blue Shield of Alabama. After completion of the online application, it may also be printed and submitted to other participating parties.

If you want to use the Alabama Uniform Provider Application, you will need to register first.

Registration is fast and secure!

Blank Application
If you do not intend on being credentialed by Blue Cross and Blue Shield of Alabama, you may print a blank Alabama Uniform Provider Application by selecting the link below:

Print Blank Alabama Uniform Provider Application

To Print—In order to print the blank form, you must have Adobe Acrobat Reader installed on your computer.