Provider Forms & Resources

We provide a complete toolkit of resources for your use – from provider change forms and electronic data interchange forms to claims submissions.

The Provider Resource Center provides access to some forms for accessing electronically.

Forms and Resources

To make changes to an address, NPI, tax identification number, or a group name, complete the following:

To make a chance to a provider name, complete the following:

  • If the provider is part of a group practice, complete an Provider Enrollment/Change Form and include a copy of the updated State licensure and any applicable board certificates
  • If the provider is an independent provider (private practice), complete an Group Enrollment/Change Form and include a copy of the updated State licensure and any applicable board certificates

Mental health and substance abuse clinicians need to complete the Area of Expertise form to identify their area of expertise for marketing in the Blue national directories.

Quick Links

Access additional resources and tools for providers

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