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It is important to use the Provider Demographic Update form located in the For Healthcare Providers section of Midlands Choice.com to notify Midlands Choice whenever any of the following occur:

• A new practice, billing, mailing or remit to location is added

• Changes are made to an existing location

• An existing location has closed

• An in-network physician or healthcare provider has joined your practice

• A physician or healthcare provider has left your practice

• The group practice name or tax identification number has changed

To update a provider's name, degree, and/or specialty, please email the changes to the Midlands Choice Credentialing department instead of completing the provider demographic update form. Be certain to include the effective date of the change, as well as your NPI and/or TIN in your email.

If your practice is part of a PHO or IPA, follow the procedures that you have in place to report demographic changes.

 

 

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