Provider Communications Email Sign-up Form

Complete this brief form to receive the latest news and information of interest to the Independence Blue Cross (Independence) provider community.
Note: This form should only be completed by participating providers or their intermediary, (i.e., third-party billing). If you are part of an Integrated Delivery System (IDS), please contact your Administrative office(s) Network Coordinator for Independence news and information.

Email Recipient's Information (* required fields)

*First name:
*Last name:
*Email address:

Office/Company Information

*Company name:
*Street address 1:
  Street address 2:
*State: *ZIP Code:
*Third-party billing agency: No Yes
*Provider type:

Choose provider type as applicable and select the specialty from the drop-down box

  Professional Ancillary


  Phone number:
  Name of person completing form:

Sign up for the following communications (Check all that apply)

  • Select All
  • Partners in Health UpdateSM
  • News
  • Medical Director Emails (for participating providers only)
  • Provider Bulletins (Note: Fee schedule information is restricted to contractual notification requirements.)
To ensure your privacy, all information will be sent via a secure connection. Independence will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law.

Please see our Notice of Privacy Practices for more information.