PDS Change of Address Form - Highmark Blue Shield 2026

1. Click ‘Get Form’ to open the PDS Change of Address Form in our platform.
2. Begin by entering your Provider Number and Name at the top of the form. This information is essential for identifying your provider file.
3. Fill in the Effective Date and Group Name, ensuring that all details are accurate to avoid processing delays.
4. Indicate whether you want to add or change addresses by checking the appropriate boxes for Main Practice, Additional Practice, Mailing, and Check addresses.
5. Provide the new Main Practice Address along with previous address details. Include telephone and fax numbers as well as email addresses for communication purposes.
6. If applicable, list any Additional Practice Addresses on a separate sheet and include their contact information.
7. Complete the Mailing Address and Check Address sections, confirming if a lockbox is used.
8. Finally, ensure that the Signature of Provider/Authorized Representative is included along with the printed name and date before submitting.

Start using our platform today to easily complete your PDS Change of Address Form for free!