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Get Unitedhealthcare Provider Change Of Address Form
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How to fill out the Unitedhealthcare Provider Change Of Address Form online
This guide provides detailed instructions for completing the Unitedhealthcare Provider Change Of Address Form online. Ensuring accurate and timely updates to your practice's information is essential for maintaining compliant operations.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to access the Unitedhealthcare Provider Change Of Address Form and open it in your preferred editor.
- Begin by filling out Section I, which includes group demographics. Input your practice or organization name, current tax ID, National Provider Identifier (NPI), and the date issued. Ensure all required fields marked with an asterisk (*) are completed.
- Provide your Medicaid ID number and specify your NUCC Taxonomy Code(s) in the designated fields. Ensure the taxonomy codes you list are relevant to your organization.
- Next, select the basis for your NPI from the provided options. Indicate whether it is based on the provider name, tax ID, license number, or other criteria. This step is only applicable for organizations with more than one NPI.
- Input the contact information of the individual completing the form, including their name, telephone number, and email address.
- Proceed to Section II, where you will fill in any practice or organization information changes. If applicable, update your tax ID, new address, or practice name. Ensure new address details correspond accurately to the type of address specified.
- In this section, you can report changes regarding physicians or healthcare providers joining or leaving your practice, including their effective dates and reasons.
- Continue with Section III to complete the National Provider Identification requests. Fill out the NPI collection grid with organization or sub-part NPI numbers, names, taxonomy codes, basis for NPI, and level information. If you have more NPIs than the grid allows, refer to the additional tracking template.
- Finally, review all the entered information for accuracy. Once confirmed, select the option to save your changes, download a copy, print, or share your completed form as necessary.
Ensure your practice's information is always up-to-date by completing the Unitedhealthcare Provider Change Of Address Form online.
To update your address for UnitedHealthcare, complete the UnitedHealthcare Provider Change Of Address Form. This form can usually be found on their website and should be submitted as directed. Updating your address is essential to make sure you receive all communications related to your health plan without any interruptions.
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