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Maintaining & Changing Status

For changes related to You should
  • Tax ID
  • Joining/opening a new practice
  • Leaving your current practice
  • Adding a product to an existing contract
  • Discontinuing being a primary care provider with a panel of patients
Complete the Contract Update Form for your provider type.
  • Contract terminations (leaving all Blue Cross practices)
Submit a Standardized Provider Information Change Form.
  • Hospital affiliations
  • Accepting or not accepting new patients
  • Closing/re-opening your PCP panel (if you are a primary care provider)
Update your CAQH ProView record or submit a Standardized Provider Information Change Form.

Diagnostic imaging privileging changes

If you Then
Have professional privileges No new professional privileging application is required.
Have technical privileges but are moving, adding a site, or joining a new practice You must submit a Limited Technical Privileging Application for your new location.
Are not currently approved for either professional or technical privileging Go to the Privileging page and download the applicable privileging application.

For more information about privileging, visit our Privileging page.

If you’re newly licensed as a different provider type, you will need a new contract. Submit the appropriate contracting application.

For changes related to your clinical profile in our provider directory, complete the clinical profile form.

For changes related to You should
  • Tax ID
  • Joining/opening a new practice
  • Leaving your current practice
  • Adding a product to an existing contract
  • Discontinuing being a primary care provider with a panel of patients
Complete the Contract Update Form for your provider type.
  • Contract terminations (leaving all Blue Cross practices)
Submit a Standardized Provider Information Change Form.
  • Hospital affiliations
  • Accepting or not accepting new patients
  • Closing/re-opening your PCP panel (if you are a primary care provider)
Update your CAQH ProView record or submit a Standardized Provider Information Change Form.

Clinicians: Keep directory information current
We're required by law to keep our provider directories current and up-to-date, including whether you are accepting new patients. You are also obligated by your Blue Cross provider Agreement to do so. Your updates are critical, so members have the most accurate information. Even if your information is accurate today, please be sure to submit changes as they arise throughout the year.

For practice or contact information changes, such as changes to your address or phone number, use the Standardized Provider Information Change Form or the Sale of Dental Practice Form. Fax completed forms to 617-246-9397.

For changes related to

  • New dentist joining your group
  • New Tax ID Number (TIN)
  • Joining a practice
  • Opening a practice
  • Adding another product or network to your contract
  • Your new legal name

Email or call your Dental Network Manager. Refer to the chart below for your contact.

For practices located in: Your Dental Network Manager is:
North Shore and New Hampshire Jill Gibbons
(617)246-7095
Jill.Gibbons@bcbsma.com
South Shore, Cape Cod, and the Islands David Brow
(617)246-4087
David.Brow@bcbsma.com
Central & Western Massachusetts Please contact dentalnetworkrequest@bcbsma.com
Boston and Metro-West Patricia Crossen
(617)246-9498
Patricia.Crossen@bcbsma.com

 

This page applies to MDs and DOs, but not psychiatrists, podiatrists, or chiropractors (see Behavioral Health or Ancillary professionals).

For changes related to You should
  • Tax ID
  • Joining/opening a new practice
  • Leaving your current practice
  • Adding a product to an existing contract
  • Discontinuing being a primary care provider with a panel of patients
Complete the Contract Update Form for your provider type.
  • Contract terminations (leaving all Blue Cross practices)
Submit a Standardized Provider Information Change Form.
  • Hospital affiliations
  • Accepting or not accepting new patients
  • Closing/re-opening your PCP panel (if you are a primary care provider)
Update your CAQH ProView record or submit a Standardized Provider Information Change Form.

If you're not credentialed by us and you're joining or opening a new practice

Complete the:

  1. HCAS Enrollment Form (see the Resource Documents section on hcasma.org)
  2. Physician Group Application (Type 2 NPI required).

If you are becoming a concierge practice

Review our Concierge Practice fact sheet.


For changes related to:

  • Business and billing addresses
  • Adding or closing a service site*
  • Tax ID
  • Ceasing business or will no longer provide services in Massachusetts
  • Reporting a new DBA (doing business as name)
  • Providing new services
  • Adding a product to an existing contract

Complete the Update Form for Facilities.

*Note: You must also submit a provider application if you are:

  • Moving your only service site, or
  • You are one of the following provider types:
    Ambulatory Surgi-Center
    Assisted Reproductive Technology
    Behavioral Health Facility
    Behavioral Health or State Hospital
    Chronic or Long Term Care Hospital
    Community Mental Health Center
    Early Intervention Program
    Freestanding Clinical Laboratory
    Freestanding Sleep Study Facility/
        Out of Center Testing
    Home Health Care
    Home Infusion Therapy
    Opioid Treatment Program
    Rehabilitation Hospital
    Skilled Nursing Facility
    Technical Diagnostic Imaging
    Transitional Care Unit
    Urgent Care Center

Changing your practice location or phone number?

For non-demographic changes, please refer to the pages on the left.

We require all providers to maintain their data in our provider directories.

Faxing a Provider Information Change Form? Tell us how to use your data

Do you want members to call you at your new phone number/visit you at your new address? We will assume the answer is “yes” and add your changes to our provider directory unless you tell us not to.

If your changes are for our records and NOT for use by members, please write a note (where space allows) on the Provider Information Change Form before faxing us.

We require all providers to maintain their data in our provider directories

We use the information you enter in CAQH ProView to update our provider directories, so it is important to validate your information on a quarterly basis. If you do not keep your data current, or if you do not regularly review and attest to its accuracy, you could be removed from our directory.

To validate the information on our website:

  1. Go to Find a Doctor & Estimate Costs.
  2. Fill in your name or your facility name and ZIP code.
  3. Enter a network (example: HMO Blue) and click Search.
  4. Review the information for all your site locations.*
Be sure to validate:
  • Addresses
  • Board certification
  • Gender
  • Hospital affiliations
  • Languages spoken
  • Medical groups
  • Phone numbers for scheduling appointments
  • Specialties
  • Whether you are accepting new patients
  • Whether you offer telemedicine

*Only addresses where members can make appointments will display in the directory.

Questions?

  • Medical providers, please email Providercredenroll@bcbsma.com with your inquiries regarding credentialing and provider enrollment. If you need to call us, you can reach us at 1-800-316-BLUE.
  • Dental providers, call Dental Network Management at 1-800-882-1178, Option 4 or email us at DentalNetworkRequests@bcbsma.com.

This page applies to nurse practitioners (NPs), certified nurse midwives, certified registered nurse anesthetists, and physician assistants (PAs).

To be recognized as a primary care provider with a panel of patients, submit the appropriate contracting application (for PA-PCPs or NP-PCPs).

To discontinue being a primary care provider with a panel of patients, submit the appropriate Contract Update form.

For changes related to You should
  • Tax ID
  • Joining/opening a new practice
  • Leaving your current practice
  • Adding a product to an existing contract
  • Discontinuing being a primary care provider with a panel of patients
Complete the Contract Update Form for your provider type.
  • Contract terminations (leaving all Blue Cross practices)
Submit a Standardized Provider Information Change Form.
  • Hospital affiliations
  • Accepting or not accepting new patients
  • Closing/re-opening your PCP panel (if you are a primary care provider)
Update your CAQH ProView record or submit a Standardized Provider Information Change Form.