Provider Demographic Updates

Provider Demographic Updates

Log in to My Insurance Manager^SM or register for My Insurance Manager, and use M.D. Checkup to make demographic updates quickly and easily.

Use M.D. Checkup To:

1. Update the practice address. 
2. Change or add where an already-enrolled physician practices within your group (must have the same tax ID). 
3. Terminate a provider. 
4. Update office or directory information.

Other Provider Updates

The following updates can be made through My Provider Enrollment Portal.

• Authorization to Bill — Add a practitioner affiliation to a new group.
• Change of Address Form — Update billing address(es).
• Doing Business as (DBA) Name Change Form — Change the name of the practice.
• Request To Add or Terminate Practitioner Affiliation — Add, terminate or change a practitioner's affiliation.
• Satellite Location Application — Add a new location to file claims to an existing group or change your tax identification number.