Independence would like to remind you that, per your Independence
Professional Provider Agreement and/or
Hospital, Ancillary Facility, or Ancillary Provider Agreement (Agreement), you
are required to notify Independence
whenever key provider demographic information changes. Submitting changes in a
timely manner helps to ensure
prompt payment of claims, delivery of critical communications, seamless
recredentialing, and accurate listings in our
provider directories.
Professional providers*
Independence requires at least 30 days advanced notice to process most
updates as long as the information
submitted is accurate. For a complete outline of the advanced notice time
frames that Independence requires
to process most updates, refer to the Administrative Procedures section of the
Provider Manual for Participating
Professional Providers (Provider Manual). Most of the changes to basic
practice information can be quickly submitted
using the Provider Change Form.
Note: The Provider Change Form cannot be used if you are
closing your practice or terminating from the network. Refer to ?Resignation/
termination from the Independence network? in the Administrative Procedures
section of the
Provider Manual for more information regarding policies and procedures
for resigning or terminating from the network.
Facility and ancillary providers
As outlined in the Administrative Procedures section of the Hospital
Manual for Participating Hospitals, Ancillary
Facilities, and Ancillary Providers, Independence requires at least 30
days advanced written notice to process
changes to your information as long as the information submitted is
accurate.
Per your Agreement, all changes must be submitted in writing to our
contracting and legal departments at the following
addresses:
- Independence Blue Cross
- Attn: Vice President, Contracting and Reimbursement
- 1901 Market Street, 27th Floor
- Philadelphia, PA 19103
- Independence Blue Cross
- Attn: Deputy General Counsel, Managed Care
- 1901 Market Street, 43rd Floor
- Philadelphia, PA 19103
Authorizing signature and W-9 Forms
Updates resulting in a change on your W-9 Form (e.g., changes to a
provider?s name, tax ID number, billing vendor or
?pay to? address, or ownership) require the following signatures:
- For professional providers:
- For facility and ancillary providers: Written
notification on company letterhead is required. An updated copy
of your W-9 Form reflecting these changes must also be included to ensure that
we provide you with a correct
1099 Form for your tax purposes. If you do not submit a copy of your new W-9
Form, your change will not be
processed.
Independence will not be responsible for changes not processed due
to lack of proper notice. If you have any
questions about updating your provider information, please contact your Network
Coordinator.
* To ensure appropriate setup in Independence systems,
the timelines outlined above also apply to behavioral health providers
contracted with
Magellan Healthcare, Inc., an independent company, but they must submit any
changes to their practice information to
Magellan via their online Provider Data Change form by selecting the
?Display/Edit Practice Info? link or by contacting their Network
Management Specialist at 1-800-866-4108 for assistance.
Magellan Healthcare, Inc., an independent company,
manages mental health and substance abuse benefits for most Independence Blue
Cross members.