Make Provider Changes
All general provider changes including changes in office demographics, must be submitted in writing to MedStar Family Choice no less than thirty days prior to the desired effective date on the notice. Please follow the link to a demographic fax form that can be completed and faxed to Provider Relations at 410-933-3077 for changes in reference to: Office and billing address changes as well as changes to a Tax ID.
Changes to Tax ID numbers require 45 days written notice from the provider. MedStar Family Choice will confirm receipt of the Tax ID notice in writing within 30 days after acceptance of the Tax ID change.
Written notification for all changes must include:
- The Provider's Name and or The Employer's Name
- A Contact Person
- Tax ID Number
- What date the change is to be effective
- What the information is changing from
- What the information is changing too
- W-9 if applicable (Required for Tax ID and Billing Address changes)
Please note. Provider terminations are not considered changes and a 90 day written notice is required as per participation agreements.
Please fax and/or mail all provider information changes to:
MedStar Family Choice
8094 Sandpiper Circle, Suite O
Baltimore, Maryland 21236
ATTN: Provider Relations Department
Should you need additional information on this topic please call MedStar Family Choice Provider Relations at 1-800-905-1722, Option 6.