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Clinicians: Keep directory information current
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, phone number, or panel status, use the Standardized Provider Information Change Form.

Important fields: 

  • Medical groups
  • Hospital affiliations
  • Board certification
  • Languages spoken
  • Whether you are accepting new patients

For other changes, choose a category below.

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Physician Assistants and Ancillary Advanced Practice Nurses Nurse practitioners (NPs), certified nurse midwives, certified registered nurse anesthetists, physician assistants (PAs)
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Contact information changes

For changes to your

  • Physical and mailing addresses
  • Phone number

Go to CAQH to update your recredentialing application. You also need to complete the Standardized Provider Information Change Form.

Contractual changes
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NPs or PAs not recognized as a primary care providers

To make changes related to

  • Tax ID
  • Practice billing updates
  • Joining/opening a new practice
  • Hospital affiliations or privileges
  • Adding a product to an existing contract

Complete the Contract Update Form for Physician Assistants and Ancillary Advanced Practice Nurses.

To be recognized as a primary care provider with a panel of patients

Complete the PA-PCP and NP-PCP Contracting Application.

NPs or PAs who are recognized as a primary care providers

To make changes related to

  • Tax ID
  • Practice billing updates
  • Joining/opening a new practice
  • Hospital affiliations or privileges
  • Adding a product to an existing contract

Complete the Contract Update Form for Nurse Practitioner-PCPs and Physician Assistant-PCPs.

To discontinue being a primary care provider with a panel of patients

Complete the Contract Update Form for Physician Assistants and Ancillary Advanced Practice Nurses.

For contract terminations or closing/re-opening your PCP panel

Complete the Standardized Provider Information Change Form.

Ancillary Professionals
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Contact information changes

For changes to your

  • Physical and mailing addresses
  • Phone number

Go to CAQH to update your recredentialing application. You also need to complete the Standardized Provider Information Change Form.

Contractual changes

For changes related to

  • Tax ID
  • Practice billing updates
  • Joining/opening a new practice
  • Hospital affiliations or privileges
  • Adding a product to an existing contract

Complete the Contract Update Form for Ancillary Professional Providers.

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

For contract terminations

Complete the Standardized Provider Information Change Form.

Network & product participation changes

If you’re newly licensed as a different type of Ancillary Professional

Complete a contracting application.

Privileging changes

Diagnostic imaging services

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.

Behavioral Health Professionals
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Clinical profile changes

To make clinical updates to our online directory

Complete the Clinical Profile Form.

Contact information changes

For changes to your

  • Physical and mailing addresses
  • Phone number

Go to CAQH to update your recredentialing application. You also need to complete the Standardized Provider Information Change Form.

Contractual changes

For changes related to

  • Tax ID
  • Joining/opening a new practice
  • Adding a product to an existing contract

Complete the Contract Update Form for Behavioral Health Professionals.

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

For contract terminations

Complete the Standardized Provider Information Change Form.

Network & product participation changes

If you’re newly licensed as a different type of behavioral health professional

Complete a contracting application.

Doctors (MDs and DOs; not psychiatrists, podiatrists, or chiropractors)
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Contact information changes

For changes to your

  • Physical and mailing addresses
  • Phone number

Go to CAQH to update your recredentialing application. You also need to complete the Standardized Provider Information Change Form.

Contractual changes

For changes related to

  • Primary care status
  • Tax ID
  • Practice billing updates
  • Joining/opening a new practice
  • Hospital affiliations
  • Adding a product to an existing contract

Complete the Contract Update Form for Physicians.

If you're not credentialed by us and you're

  • Joining or opening a new practice

Complete the HCAS Enrollment Form and the Physician Group Application (Type 2 NPI required).

For contract terminations and closing/re-opening your PCP panel

Complete the Standardized Provider Information Change Form.

If you are becoming a concierge practice

Review our concierge practice fact sheet.

Hospitals/Facilities/Labs

For changes related to

  • Physical and mailing address
  • Phone number
  • 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)
  • Recontracting with us
  • Providing new services
  • Adding a product to an existing contract
  • All other changes

Complete the Update Form for Facilities.