Maintaining & Changing Status

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Behavioral Health Professionals

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. 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.

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