Get Change Of Address Form - Humana Military

Completing the Change of Address Form for Humana Military is a straightforward process that helps ensure your information is up-to-date. This guide will walk you through each section of the form to assist you in making the changes efficiently.

Follow the steps to complete the online form

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. In the Provider Name section, clearly print your last name, first name, and middle initial to identify yourself.
3. Provide your Social Security number and NPI number as required to link your information.
4. Indicate your intention by checking the appropriate box for either 'ADD location' or 'CHANGE location or information'.
5. Enter the effective date for your address change and remember that processing may take up to 30 days from the receipt date.
6. Specify whether this is a new primary location by answering 'Yes' or 'No' and then fill in your complete address, ensuring that no PO boxes are used.
7. Provide the county, email address, phone number, and fax number for your new location.
8. If this is a new Tax ID, submit a W-9 form and fill in the Tax ID number and corresponding NPI number.
9. Indicate your designated primary address for NPI along with the matching Tax ID name.
10. List your hours of operation for each day of the week, noting if the location is handicapped or public transportation accessible.
11. If applicable, specify if the TIN is assigned to someone other than yourself and obtain the required signature for authorization.
12. Provide your new billing address along with the associated contact numbers.
13. List any locations you wish to delete along with the corresponding Tax ID numbers.
14. Answer whether your mailing address will change and, if so, provide the new mailing address.
15. If you have additional practice locations, please attach a list as required.
16. Finally, print your name and the date the form is completed to finalize the submission.

Take a moment to complete the CHANGE OF ADDRESS FORM online to ensure your records are accurate.