PRACTITIONER AFFILIATION AGREEMENT FORPractitioner Affiliation Agreement • January 30th, 2022 • Michigan
This Agreement is made by and between BLUE CROSS AND BLUE SHIELD OF MICHIGAN, a Michigan nonprofit healthcare corporation (BCBSM), and the undersigned Practitioner who is fully licensed or legally authorized to practice in the state of Michigan (TRUST PRACTITIONER).
PRACTITIONER AFFILIATION AGREEMENTPractitioner Affiliation Agreement • February 1st, 2023 • Michigan
This Agreement shall be effective by and between Blue Care Network of Michigan (BCN), a nonprofit Michigan corporation and health maintenance organization and independent licensee of the Blue Cross Blue Shield Association (BCBSA) and (Practitioner).
PRACTITIONER AFFILIATION AGREEMENTPractitioner Affiliation Agreement • November 13th, 2022 • Michigan
This Agreement is made between Blue Care Network of Michigan, Blue Care of Michigan, Inc. and BCN Service Company (hereinafter collectively referred to as Health Plan) and (hereinafter referred to as Provider), a Michigan licensed health care practitioner.
BLUE CROSS COMPLETE OF MICHIGAN PRACTITIONER AFFILIATION AGREEMENT SIGNATURE PAGEPractitioner Affiliation Agreement • July 24th, 2020
IN WITNESS WHEREOF, the parties wishing to be bound by the terms and conditions of the Blue Cross Complete of Michigan Practitioner Affiliation Agreement (NOV2012) have affixed their signature on this Signature Document, which is incorporated by reference in the Blue Cross Complete of Michigan Practitioner Affiliation Agreement appropriate to practitioner’s specialty. The Agreement effective date will be established by Blue Cross Complete of Michigan (BCC) and documented on the original counter- signed Agreement returned to the Provider upon completion of the affiliation process.
PRACTITIONER AFFILIATION AGREEMENTPractitioner Affiliation Agreement • July 29th, 2020
This amendment (Amendment) to the Practitioner Affiliation Agreement (Agreement) by and between Blue Care Network of Michigan, Blue Care of Michigan, Inc. and BCN Service Company (hereinafter collectively referred to as BCN) and _ (Practitioner) shall be effective .
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement(s) you check below.Practitioner Affiliation Agreement • December 4th, 2014
Managed care network affiliations do not become active until the credentialing process has been successfully completed and the relevant contracts have been signed.
Individual Signature DocumentPractitioner Affiliation Agreement • December 15th, 2014
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement checked below.
Individual Signature DocumentPractitioner Affiliation Agreement • December 8th, 2014
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement checked below.
BLUE CROSS COMPLETE OF MICHIGAN PRACTITIONER AFFILIATION AGREEMENTPractitioner Affiliation Agreement • October 21st, 2022 • Michigan
This Agreement is effective (Date to be entered only by Health Plan) for an initial term through the end of the calendar year. The Agreement shall renew automatically for additional one-year terms unless otherwise terminated as provided below.
Individual Signature DocumentPractitioner Affiliation Agreement • September 5th, 2020
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement checked below.
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement(s) you check below.Practitioner Affiliation Agreement • December 12th, 2014
Managed care network affiliations do not become active until the credentialing process has been successfully completed and the relevant contracts have been signed.
BLUE PREFERRED PLUS PRACTITIONER AFFILIATION AGREEMENT SIGNATURE PAGEPractitioner Affiliation Agreement • September 26th, 2022
IN WITNESS WHEREOF, the parties wishing to be bound by the terms and conditions of the BPP Practitioner Affiliation Agreement (Jan2010) have affixed their signature on this Signature Document, which is incorporated by reference in the BPP Practitioner Affiliation Agreement appropriate to practitioner’s specialty. The Agreement effective date will be established by BCN and documented on the original counter-signed Agreement returned to the provider upon completion of the affiliation process.
Individual Signature DocumentPractitioner Affiliation Agreement • December 11th, 2014
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement checked below.
Individual Signature DocumentPractitioner Affiliation Agreement • December 8th, 2014
Your signature below establishes your commitment to be legally bound by the terms and conditions of the Practitioner Affiliation Agreement checked below.
