If you are a group (Billing NPI Type 2) and have more than five changes, please send a request to to obtain a current copy of your roster to initiate your multiple change request. Medical Group Change for Multiple Providers If you are an existing provider who needs to report a legal name change, complete a new contract application to initiate the update process. Credentialing is required for Professional Provider Types: MD, DO, PSYD, DC, CNM, LCSW, LCPC, LMFT, DPM, PA, APN, CNP, RD, LAC and DN. Note: CAQH Credentialing Application must be complete prior to completing this form. BCBSIL will send a letter to the contracted group once complete. If credentialing is required, the process can take 30–120 days. Processing can take 30 days if Credentialing is not required. The provider being added to the group will not be considered in network until they are appointed into the network. Due to the credentialing requirements, changes are not immediate upon submission of this form. If you need to add a provider to your current contracted group, complete the Provider Onboarding Form to initiate the process. Administrative/Correspondence Address/Telephone/Fax/Email.Credentialing Address/Telephone/Fax/Email.Office Physical Address/Telephone/Fax/Email/Hours of Operation (Note: When submitting changes, please indicate in the comments section if you are “adding a location” or “changing a location”.).If you have completed a Demographic Change Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker.Įxamples of information you can change include: If you need to change existing demographic information, complete the Demographic Change Form. 1, 2019, commercial provider demographic changes will be visible in our online Provider Finder ® within 10 business days after the change request is received by BCBSIL. This is just one of the reasons why it’s very important that you inform Blue Cross and Blue Shield of Illinois (BCBSIL) whenever any of your practice information changes.īeginning Jan. When seeking health care services, our members often rely upon the information in our online Provider Finder ®.

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