Z6_VA6HBFH208OD80IVLJPH4R00M2
Home > Office Resources > Enrollment > Maintaining & Changing Status
Z7_VA6HBFH208OD80IVLJPH4R00M7
Web Content Viewer
Z7_VA6HBFH208OD80IVLJPH4R00E2
Web Content Viewer
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.

The Change Form is managed by the Mass Collaborative.
  • Hospital affiliations
  • Accepting or not accepting new patients
  • Closing/re-opening your PCP panel (if you are a primary care provider)
 Update your CAQH Provider Data Portal (formerly 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 Go to the Privileging page and download the applicable privileging application.
Are not currently approved for either professional or technical privileging

If you are becoming a concierge practice

Review our Concierge Practice fact sheet.

Z7_VA6HBFH208OD80IVLJPH4R00E5
Related Content

Related Content

CAQH Provider Data Portal
Credentialing Q & As
Credentialing and recredentialing
Z7_VA6HBFH208OD80IVLJPH4R00E7
Web Content Viewer

Try our patient resources

Avoid claim rejects when your patient has more than one insurance

Learn about billing agency access