Provider Information Update Form
Care N’ Care highly encourages providers to keep their demographic information updated. Providers contracted through an IPA (Independent Practice Association), must contact their IPA Representative to submit updates to Care N’ Care.
Guide to Provider Forms
You will need to complete the sections identified on the Provider Update Form and any additional documents listed. All documents must be completed and returned to Provider Concierge Department either by fax to 682-503-5427 or email at firstname.lastname@example.org.
If you are needing to:
- Add a new provider to an existing agreement
- Change a TIN (Tax Identification Number) to an existing agreement
- Term notice
Email Contracting Department at email@example.com with your detailed request.