Welcome to Anthem Blue Cross and Blue Shield

CAQH ID Number Request Form

This CAQH ID Number Request Form should be used only by Colorado physicians, providers and professionals to apply for a CAQH ID Number.

Providers that require credentialing by Anthem must apply for a CAQH ID before applying for participation in our Anthem networks because a CAQH ID is required on our New Provider Application Form. The CAQH ID Number Request Form should be completed only by those provider types required to apply for a CAQH ID. (Note: If your provider type is not listed, you do NOT need to apply for a CAQH ID number. Please proceed directly to the New Provider Application Form.)

Provider 

 

  • CAQH

    Provider Information












    Primary Practice Address





    Contact/Submitter Information


By clicking on the tab marked "SUBMIT" below, I agree as a condition of practicing in Colorado, to be subject to the jurisdiction and disciplinary authority of the appropriate agency. In addition, I hereby request the above changes and certify that the foregoing information is true and correct and that I am the named professional or am otherwise authorized to make this request and certification on behalf of the named professional.