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...Fee schedule request form the is a key component of your contractual relationship with blue cross and shield oklahoma bcbsok listing accepted charges or established allowances for specified procedure codes are not guarantee payment participating providers accept responsibility verifying identity eligibility coverage patient member prior to rendering services provider name npi if applicable billing tax id city state zip county address where rendered telephone number date email would you like receive monthly yes no bluereview publication at this by way signature in accordance agreement agrees an obligation confidentiality including but limited maximum reimbursement allowance acknowledges has been entered into division health care service corporation mutual legal reserve company independent licensee association authorized signatory title signed oknetworkmanagement com fax...