Provider Updates

Provider Updates

Need to make updates to your information on file at Healthcare Highways?

The “Provider Updates” online form below enables you to make demographic changes such as:

  • Provider Name
  • Provider Address
  • NPI Number
  • Tax Identification Number (TIN)

Please complete the online form as needed. You can either attach additional pertinent documents (such as your W9, or licensure) to the online form before submission, or send them separately to HCH via email or secure fax. When sending additional documents via email or secure fax, please note “Provider Update” in the subject line of your communication, and let us know that you have also sent information via our online website form, so we can ensure that we have received all information submitted.

Please allow up to ten (10) business days for HCH to make the requested changes in our system.

Comments or questions are welcome.

* indicates required field

Address Changes

Other Changes (Corporate or Personal)

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.

Your typed name in this field serve as a signature on this form.

Please call Service Operations (866) 945-2292 if you have any questions. Please allow 10 business days for your change to be processed.