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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.

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.

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.