PROVIDER INFORMATION UPDATES

If is very important that we have current, and up-to-date information related to your practice. Examples of reportable items include changes to:

o   Practice address
o   Practice contact information
o   Practice Tax Identification Number (TIN)
o   Remittance and payment address
o   Hours of operation
o   Panel statuses (accepting or not accepting new patients)
o   New associates joining your practice (including mid-level practitioners)

Please report changes to our Provider Relations Department using the following forms:

o   Address and Billing Information Change Form 
o   Panel Status Change Form