Submit the following documents:

• BCBSIL Credentialing Submission document identifying network and contract information.
• The State of Illinois Health Care Professional Credentialing and Business Data Gathering Form.
• BCBSIL Attestation signed and dated within 60 days of submission.
• BCBSIL Hospital Verification form completed by the Hospital.*
• Current State Medical License.
• Current Federal DEA.
• Current Controlled Substance License.
• HMO practitioners must submit a Medical Group Service Agreement.

*Forward to the practitioner's primary admitting hospital the "BCBSIL request of Hospital Privileges" to be completed by the hospital staff.