Incorrect Provider Data Found

Please note: 
For updates to in-network/participating providers with Michigan, Louisiana, Kansas, Arkansas & Walmart:   

  • If you're speaking with the provider, please instruct them to update their information directly with the plan, either via the plan website or contacting their plan provider representative as appropriate.
  • If you’re speaking with a member, please report using Datix.  

For updates and adds for out-of-network/non-participating or BlueCard providers:
  • Use the Provider Information for Authorizations (PIA) form here:

For updates to in-network/participating providers contracted with Lucet (Alabama, Florida, Kansas City, and Arkansas FEP):
  • If you're speaking with the provider, please ask them to update their information via the Lucet provider website under the Profile Updates section:
  • If you're speaking with a member, please continue use of this form.
Information
Please note this MUST be an individuals NPI or we cannot make the changes.
Does the incorrect information/update apply to the provider/facility as a whole or is it specific to one address? 
Please only list the street address.