Provider Section

Whether your an existing provider in our network looking for patient authorization or a new provider looking to join our network. We can assist you with getting you all the information you need.

Need initial authorization, benefit information or claims information?

Contact our Provider Line at: 630-646-5370.

 

Provider Authorization Forms

Therapist Treatment Authorization Request-
UNDER 20 visits

Complete this form if you are a provider seeking treatment
authorization for a patient who has had UNDER 20 visits.

Complete Form

Therapist Treatment Authorization Request-
OVER 20 visits

Complete this form if you are a provider seeking treatment
authorization for a patient who has had OVER 20 visits.

Complete Form

Psychiatrist/APN
Treatment Request Form

Complete this form if you are a provider seeking medication management authorization with a psychiatrist/APN for a patient.

Complete Form

Psychiatrist Psychological or Neurological Testing Request Form

Complete this form if you are a psychiatrist seeking authorization for psychological testing or neurological testing.

Complete Form

Psychiatrist TMS
Request From

Complete this form if you are a psychiatrist seeking Transcranial Magnetic Stimulation (TMS) treatment for a patient.

Complete Form

Are you a provider who wants to join the BCP network?

Fill out our BCP Provider Network Screening Form below. Return this form via fax to 630-646-5477.