BCBSTX Contract/Agreement Network Participation Online Request Form

Note: You must obtain a BCBSTX Provider Record ID before you complete the BCBSTX Contract/Agreement Network Participation Online Request Form.

To access the online request form from your local Professional Provider Network office, please click in the appropriate county section in the Texas map below to direct your submission. If unsure of a county location, rest the cursor on a county for a pop-up to verify its name. If you have any questions, please contact your local Professional Provider Network office.