Provider Demographic Updates

Provider Demographic Updates

Log in to My Insurance ManagerSM 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.