MedStar Family Choice requires participating providers and/or groups to submit written notification of all changes regarding their practice prior to the change(s) effective date.
Changes that require written notification prior to the change(s) effective date are:
- Participation status (90 days notification is required for terminations)
- Group/ Doing Business As (DBA) names
- Tax ID numbers (45 days notification is required for changes)
- Service location addresses (additions and closings)
- W-9 name
- W-9 addresses
- Billing addresses
- Telephone / Fax numbers
Providers and/or group written notifications must include the Provider's name, TIN, authorizing signature, contact information for inquiries and a description of the change along with the effective date. Once the appropriate documentation has been received, MedStar Family Choice will update the information to reflect the change in our systems. Failure or delay in submitting provider and/ or group change information may result in a delay of claims payment or claims denial.
- All changes in regards to billing and Tax ID must be accompanied by an updated W-9 Form or the change can not be processed.
It is also important to note that Provider, Group and/or Tax ID changes may require the completion of new contracts to retain participation status.
Please fax and/or mail all provider information changes to:
MedStar Family Choice
5233 King Avenue, Suite 400
Baltimore, Maryland 21237
ATTN: Provider Relations Department