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Demographic Change Form Complete this form when updating the billing, practice, and contractual notice demographic information for a group or solo provider. Email the completed form(s) to Provider.AddressUpdts@bcbsnc.com
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How to fill out provider change of address
How to fill out provider change of address
01
Obtain the provider change of address form from the appropriate governing body or insurance company.
02
Fill out the form completely with accurate information, including the provider's name, old address, new address, contact information, and any other required details.
03
Make sure to sign and date the form before submitting it to the appropriate party for processing.
04
Keep a copy of the completed form for your records.
Who needs provider change of address?
01
Healthcare providers who have changed their place of practice or business location.
02
Insurance companies that need updated provider information for their network directories.
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What is provider change of address?
Provider change of address is the process of updating the contact information of a service provider.
Who is required to file provider change of address?
Any service provider who has changed their contact information is required to file a provider change of address.
How to fill out provider change of address?
To fill out provider change of address, the service provider needs to complete the necessary form with updated contact information and submit it to the appropriate authority.
What is the purpose of provider change of address?
The purpose of provider change of address is to ensure that the service provider's contact information is up to date and accurate for communication purposes.
What information must be reported on provider change of address?
The information that must be reported on provider change of address includes the service provider's name, old contact information, new contact information, and effective date of the change.
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