PRACTITIONER AFFILIATION AGREEMENTPractitioner Affiliation Agreement • November 8th, 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 • 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.
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 .
PRACTITIONER AFFILIATION AGREEMENTPractitioner Affiliation Agreement • January 28th, 2022 • 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).
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.
