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How do I report a name/address change or a change in my tax identification number?

You can print a copy of the appropriate change form online by selecting Provider Forms in the Provider drop-down menu. You can also contact HealthChoice Network Management and a change form will be sent to you. Please complete and return the change form as soon as possible using the fax number provided on the form. If you make a change to your TIN, please enclose an updated W-9 form as verification. When your change form is received, the provider database will be updated and your new information will be forwarded to the claims administrator. The HealthChoice Provider Contract requires that all changes be reported to HealthChoice within 15 days of the date of the change.

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