Provider Demographic Updates

Provider Demographic Updates

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

Use MD 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/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.

Still need help? Contact us.