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Make Provider Changes

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

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.

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 our main office:

MedStar Family Choice
5233 King Ave., Suite 400
Baltimore, MD 21237
ATTN: Provider Relations Department
Fax: 855-600-3077

Should you need additional information on this topic please call MedStar Family Choice Provider Relations at 855-210-6203.

Information current as of: 10/09/17