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Blue Cross BlueShieldof IllinoisBENEFIT PROGRAM APPLICATION (BPA) (All items are applicable to 50 and under Grandfathered and Grandfathered Insured Group Accounts unless otherwise specified.)(All
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Provider information change request is a form used to update or correct information about a healthcare provider.
Healthcare providers or their authorized representatives are required to file provider information change request.
Provider information change request can be filled out manually or electronically, and must include accurate and up-to-date information.
The purpose of provider information change request is to ensure that accurate information about healthcare providers is maintained in the system.
Provider information change request must include updated contact information, practice location, specialties, and any other relevant information.
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