For changes related to | You should |
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Complete the Contract Update Form for your provider type. |
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Submit a Standardized Provider Information Change Form. The Change Form is managed by the Mass Collaborative. |
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Update your CAQH Provider Data Portal (formerly ProView) record or submit a Standardized Provider Information Change Form. |
If you | Then |
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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 |
---|---|
|
Complete the Contract Update Form for your provider type. |
|
Submit a Standardized Provider Information Change Form. The Change Form is managed by the Mass Collaborative. |
|
Update your CAQH Provider Data Portal (formerly 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
Email or call your Dental Network Manager. Refer to the chart below for your contact.
For practices located in: | Your Dental Network Manager is: |
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North Shore and New Hampshire | Katie O’Brien 1-617-246-5218 Kathleen.obrien@bcbsma.com |
South Shore, Cape Cod, and the Islands | David Brow 1-617-246-4087 David.Brow@bcbsma.com |
Central & Western Massachusetts | John Basile 1-617-246-8901 John.Basile@bcbsma.com |
Boston and Metro-West | Please email questions to dentalnetworkrequests@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 |
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|
Complete the Contract Update Form for your provider type. |
|
Submit a Standardized Provider Information Change Form. The Change Form is managed by the Mass Collaborative. |
|
Update your CAQH Provider Data Portal (formerly ProView) record or submit a Standardized Provider Information Change Form. |
Complete the:
Review our Concierge Practice fact sheet.
For changes related to:
Complete the Update Form for Facilities.
*Note: You must also submit a provider application if:
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 |
For non-demographic changes, please refer to the pages on the left.
We require all providers to maintain their data in our provider directories.
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 use the information you enter in CAQH Provider Data Portal 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:
Be sure to validate: | |
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*Only addresses where members can make appointments will display in the directory.
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 |
---|---|
|
Complete the Contract Update Form for your provider type. |
|
Submit a Standardized Provider Information Change Form. The Change Form is managed by the Mass Collaborative. |
|
Update your CAQH Provider Data Portal (formerly ProView) record or submit a Standardized Provider Information Change Form. |