Provider Demographic Updates
Provider Demographic Updates
Log in to My Insurance ManagerSM or register for My Insurance Manager, and use MD Checkup to make demographic updates quickly and easily.
Use MD Checkup to:
- Update the practice address
- Change or add where an already-enrolled physician practices within your group (must have the same tax ID)
- Terminate a provider
- Update office/directory information
Other Provider Updates
- Authorization to Bill - Add a practitioner affiliation to a new group
- Change of Address Form - Update billing address(es)
- DBA Name Change Form (In order to update the Legal Business Name (LBN) for a provider group, we require a copy of the most current official IRS letter for the entity. Examples include an IRS LTR 147C, CP267, CP 575 A, CP 575 E, CP-224 or tax coupon 8109-C. Send to Provider.Blue.Updates@bcbssc.com) W-9s are not accepted.
- EFT and ERA Enrollment Form/EFT Terms and Conditions
- Request to Add or Terminate Practitioner Affiliation - Add, terminate or change practitioner affiliation
- Satellite Location Application - Add a new location to file claims to an existing group or change your tax identification number.
- Medicare Advantage Offshore Subcontracting Attestation - Use and submit this form to BlueCross if your practice/facility utilizes offshore subcontractors.
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