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Have you made any changes to your key provider information, such as your
mailing address or the name of your
practice? If so, please be sure to notify us.
We value your help in keeping our data files current. Accurate data files
allow us to provide you with important information on billing, claims, changes
or additions to policies, and announcements of administrative processes.
Professional providers
Please notify us of any changes to your information in one of the following
ways:
- Complete the Provider Change Form and fax or mail it to us
using the instructions at the bottom of the form.
- Contact your Network Coordinator.
Facility and ancillary providers
You are required to submit any changes to your information in writing. This
request should be sent directly to the
Senior Vice President of Contracting and the Legal Department at the addresses
below:
Independence Blue Cross
Attn: Senior Vice President, Contracting and Provider Networks
1901 Market Street, 27th Floor
Philadelphia, PA 19103
Independence Blue Cross
Attn: Legal Department
1901 Market Street, 43rd Floor
Philadelphia, PA 19103
Thirty days? advance written notice is required for processing.
Note: This information does not apply to providers contracted with
Magellan Behavioral Health, Inc., an independent company. Please contact your
Magellan Network Coordinator if you have any questions.
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