Information Change Request
When seeking health care services, our members often rely upon the information in our online Provider Finder®. This is just one of the reasons why it’s very important that you inform Blue Cross and Blue Shield of Illinois (BCBSIL) whenever any of your practice information changes.
If you need to change existing demographic information, complete the Demographic Change Form to initiate the process. Some of these changes include:
- Legal Name
- NPI/Tax ID
- Office Physical Address/Telephone/Fax/Email/Hours of Operation
- Billing Address/Telephone/Fax/Email
- Credentialing Address/Telephone/Fax/Email
- Administrative/Correspondence Address/Telephone/Fax/Email
- Other Provider Updates
Request Addition of Provider to Group
If you need to add a provider to your current contracted group, complete the Request Addition of Provider to Group Form to initiate the process. Due to the credentialing requirements, changes are not immediate upon submission of this form. The provider being added to the group will not be considered in network until they are appointed into the network. Processing can take 30 days if Credentialing is not required. If credentialing is required, the process can take 30–120 days. BCBSIL will send a letter to the contracted group once complete.
Note: CAQH Credentialing Application must be complete prior to completing this form. Credentialing is required for Professional Provider Types: MD, DO, PSYD, DC, CNM, LCSW, LCPC, LMFT, DPM, PA, APN and CNP.
Request Removal of Provider from Group
If you need to remove a provider from your group, complete the Request Removal of Provider Form to initiate the process.
Additional Information Changes
Legal Name Change for Existing Contract
If you are an existing provider who needs to report a legal name change, complete a new contract application to initiate the update process.
Medical Group Change for Multiple Providers
If you are a group (Billing NPI Type 2) and have more than five changes, please send a request to ILProviderRosterRequests@bcbsil.com to obtain a current copy of your roster to initiate your multiple change request.
Changes are not immediate upon request submission. Change(s) may take up to 30 business days.
For status of your professional contract application, or if you have questions or need to make changes to an existing contract, email email@example.com. We thank you for your patience!