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Provider Data Changes

It's important to keep your data up to date. Make changes when they occur instead of waiting for your next attestation date.

Temporary notice: Due to the current backlog of change requests, we recommend that you don't call for a status on a request submitted less than 30 days ago.

How to make changes

Professional practitioners

Data you attest to can be changed by logging in to the CAQH Provider Data Portal.

To change other data elements, you will use either a change form or your group administrator can make the changes.

Change forms

Follow the steps below to access the form you need:

  1. Go to the Enrollment page
  2. Choose the Enroll or Make Changes button
  3. Select Physicians and Professionals and click Next
  4. Choose Change an existing provider and click Next
  5. Select the option that applies to you and click Next
  6. Choose the link for the appropriate change form

Once you’ve completed the form, fax it to us using the directions on the first page.

Provider Enrollment and Change Self-Service for group administrators

Provider Enrollment and Change Self-Service is an application for group administrators. With this application, group administrators can update their information with us and enroll new practitioners within their group.

Learn more at Provider Enrollment and Change Self-Service tool for group administrators.

Facility and organizational (allied) providers

Change forms

Data you attest to can be changed online. Learn how to Update and attest to facility and organizational provider information in the Provider Data Management tool within Availity Essentials* (PDF).

To change other data elements, you’ll need to use a change form. Follow the steps below to access the form you need:

Facility providers:

  1. Go to the Enrollment page
  2. Choose the Enroll or Make Changes button
  3. Select Hospitals and Facilities and click Next.
  4. Choose your facility type and click Next.
  5. Select the link to the appropriate form in the Changes section.

Organizational (allied) providers:

  1. Go to the Enrollment page
  2. Choose the Enroll or Make Changes button
  3. Select Physicians and Professionals and click Next
  4. Choose Change an existing provider and click Next
  5. Select the option that applies to you and click Next
  6. Choose the link for the appropriate change form

Once you’ve completed the form, fax it to us using the directions on the first page.

See Provider Data Attestation for information on how to complete your required attestations.