Notify Us - Changes in Medical Professional Staff

Last modified: December 10,  2020

Your commercial contract with us obliges you to notify us of any change in Medical Professionals, including nonphysician professionals such as nurse practitioners, clinical nurse specialists and physician assistants.  

Failure to do so may result in denial of claims or incorrect payment. 

What you need to do

This obligation is met when an updated roster is submitted in writing, electronically in

• Excel
• ANSI
• text (comma delineated) formats

All data elements must be provided* in order for a roster to be considered a “clean” roster. 

If any data element is not applicable to your staff member, indicate “not applicable” in the appropriate field. 

As outlined in your contract, the required data elements are:

• Name of Professional (first name, middle initial, last name)
• Degree (MD, DO, NP, PA, CNS, other)
• Gender (M/F)
• Provider Specialty(ies) (primary, secondary, additional specialties)
• Operates as and willing to be listed/assigned as a Primary Care Professional “PCP” (Y/N)
• State License Number
• Medicaid ID Number
• NPI Number
• Foreign Language(s)
• Admitting Hospital(s)

Questions? Please contact your network management team or provider relations representative.

*with the exception of “Foreign Language(s)”