To better serve you and our members; HealthPlus must be informed promptly and in writing, of any changes related to your practice, including:
- Practice name
- Practice location
- Practice billing address
- Practice telephone numbers and fax numbers
- Tax identification number (a copy of the W-9 form MUST be submitted with the change notification)
- Names of physicians joining or leaving the practice
- Changes in the on-call reporting relationship(s) for physicians
- Each physician’s hospital affiliation
- Each physician’s Board Certification status
- Practice accepting status
- Practice e-mail address
Providing this information to HealthPlus ensures:
- Your practice will be accurately reflected in the HealthPlus provider directory.
- Payments will be sent to the correct location
- Monies will be properly reported to the IRS
- HealthPlus members will be provided the most current information regarding your practice and;
- Use of electronic communications will assist in the dissemination and distribution of important information
To inform HealthPlus of any changes in your practice, please complete and return the Provider Request Change Form.
For more information about notifying HealthPlus of changes to the Provider Network Management Department at: (810) 230-2172.