BCBSTX Contract/Agreement Network Participation Online Request Form

Note: You must obtain a Blue Cross and Blue Shield of Texas (BCBSTX) Provider Record ID before you complete the BCBSTX Contract/Agreement Network Participation Online Request Form.

Please select your specialty and fill out the corresponding form to request a BCBSTX Network Participation Contract/Agreement be sent to you.

• Anesthesia
• Emergency Room
• Hospitalist
• Neonatology
• Pathology
• Radiology