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  • Provider Demographic Change Form - Usfhp

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PROVIDER CHANGE FORM Current Group/Practice Name: Current Provider Name: Individual Provider NPI: Group NPI: Change Group/Practice Name to: Change Provider(s) Name to: Please provide supporting documentation;.

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US FAMILY HEALTH PLANS. The US Family Health Plan is a contracted TRICARE program under which the TRICARE Prime benefit is offered to eligible military beneficiaries. The US Family Health Plan requires beneficiaries to enroll and is offered through six participating non-profit plans in different regions of the country.

These demographic data include such items as the provider name, provider-mailing address, provider physical address, State, ZIP Code, etc.

Claims Filing Address (Medical only): Appeals – Medical Necessity: Appeals – Claims/Denials: US Family Health Plan US Family Health Plan US Family Health Plan PO Box 830745 NYCHSRO/MedReview 5 Penn Plaza, 9th Floor Birmingham, AL 35283-0745 1 Seaport Plaza 199 Water Street New York, NY 10001-1810 New York, NY 10038 ...

We provide the full TRICARE Prime benefit including routine doctor visits, specialty care, hospitalization, urgent and emergent care, preventative health care services, behavioral health services and full prescription coverage. USFHP members have access to some of the best hospitals and physicians in the nation.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232