New Single Form to Communicate Name, Address, and Other Office Changes to Payers Now Available
Posted on December 16, 2013
To make sure that health plans and their members have the most up-to-date information about your practice, the Mass Collaborative* is pleased to introduce the Standardized Provider Information Change Form. When you are changing your practice name, address, phone numbers, e-mail, billing company, or other practice information, you only need to complete this single form and send it via e-mail, fax, or US mail to each health plan you contract with instead of completing a different form for each health plan. The following health plans now accept this form:
- Blue Cross Blue Shield of Massachusetts
- BostonMedicalCenter Healthnet Plan
- Celticare Health Plan of Massachusetts
- Fallon Community Health Plan
- Fallon Total Care
- Harvard Pilgrim Health Care
- Health New England
- Neighborhood Health Plan
- Network Health
- Tufts Health Plan
- Senior Whole Health
- Unicare
This form should not be used to submit credentialing or contractual changes. Continue to use individual health plan forms for those changes. In some circumstances, individual health plans may need to follow up with providers for additional information regarding a demographic change. Please click the link below to access the form on www.hne.com
http://hne.com/HNE_Providers/documents/PROVIDER-INFORMATION-CHANGE-FORM.pdf
Questions?
For questions about specific health plan policies or requirements, contact Provider Relations at 413.233.3313 or toll-free at 800.842.4464, extension 5000.
* The Mass Health Collaborative is a multi‐stakeholder group committed to reducing health care administrative burdens and costs. Members of the Mass Collaborative include the Massachusetts Hospital Association, Massachusetts Medical Society, Blue Cross Blue Shield of Massachusetts, the Massachusetts Association of Health Plans, the Massachusetts Health Data Consortium, MassHealth, Healthcare Administrative Solutions, as well as many local payers and providers.
