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 benefit or claims information?

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

 

Provider Authorization Forms

Provider Initial Authorization

Complete this form if you are a provider (therapist, social worker, psychiatrist) seeking initial treatment authorization for a patient.

Complete Form

_____

Outpatient Treatment Authorization Request

Complete this form if you are a provider seeking additional treatment
authorization 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 formĀ 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.