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Physician Assistants and Advanced Practice Nurses

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
  • 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.