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PDS Change of Address Form - Highmark Blue Shield 2026
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- Click ‘Get Form’ to open the PDS Change of Address Form in our platform.
- Begin by entering your Provider Number and Name at the top of the form. This information is essential for identifying your provider file.
- Fill in the Effective Date and Group Name, ensuring that all details are accurate to avoid processing delays.
- Indicate whether you want to add or change addresses by checking the appropriate boxes for Main Practice, Additional Practice, Mailing, and Check addresses.
- Provide the new Main Practice Address along with previous address details. Include telephone and fax numbers as well as email addresses for communication purposes.
- If applicable, list any Additional Practice Addresses on a separate sheet and include their contact information.
- Complete the Mailing Address and Check Address sections, confirming if a lockbox is used.
- 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!
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2003 | 4.1 Satisfied (67 Votes) |
Does Highmark cover Wegovy for weight loss?
After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email. Please allow up to 180 days for processing as mandated by the National Committee for Quality Assurance (NCQA).
Is Highmark the same as Highmark Blue Cross Blue Shield?
An independent licensee of the Blue Cross Blue Shield Association, Highmark Inc., together with its Blue-branded affiliates, collectively comprise the fifth largest overall Blue Cross Blue Shield-affiliated organization in the country with approximately 7.1 million members in Pennsylvania, Delaware, West Virginia and
What is the address for Highmark Blue Cross Blue Shield of PA claims?
Claims Filing Addresses If type of claim isMail to Highmark Blue Shield Medical Surgical Claims Claims Processing P.O. Box 890062 Camp Hill, PA 17089-0062 Highmark Blue Shield Indemnity Major Medical Highmark Major Medical P.O. Box 890393 Camp Hill, PA 17089-039315 more rows
Does Highmark BCBS accept paper claims?
Highmark BCBS prefers the submission of claims electronically through the electronic data interchange but will accept paper claims. A paper claim must be on an original claim form with dropout red ink, computer-printed or typed, and in a large, dark font in order to be read by optical character reading technology.
Is Highmark the same as Blue Cross and Blue Shield?
Together with its Blue-branded affiliates, Highmark Inc. is collectively the fourth-largest overall Blue Cross and Blue Shield-affiliated organization in the country based on capital. Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association.
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People also ask
What is the mailing address for Highmark BCBS of PA?
Claims Filing Addresses If type of claim isMail to Classic Blue Individual Traditional Indemnity Highmark P.O. Box 890393 Camp Hill, PA 17089-0393 Medigap Signature 65 Highmark Blue Shield P.O. Box 898845 Camp Hill, PA 17089-884515 more rows
How do I contact Highmark Blue Cross Blue Shield?
BLUE CROSS BLUE SHIELD GLOBAL CORE , call the Global Core Service Center at 1-800-810-2583 (24/7) or your Dedicated Highmark Service Team. For more information, see the flyer.