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Practitioner Demographic Changes - Excellus BlueCross BlueShield

Practitioner Demographic Changes - Excellus BlueCross BlueShield 2026

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The document is a form for practitioners to report demographic changes, including updates to their contact information, specialties, and office locations. It requires specific details such as provider names, NPI numbers, and addresses, along with confirmation of accepting new patients and accessibility features. The completed form must be signed by the practitioner and submitted to designated Excellus BlueCross Blue Shield offices.

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Click ‘Get Form’ to open it in the editor.
Begin by entering today’s date and your provider name at the top of the form. Ensure accuracy as this information is crucial for processing.
Fill in the effective date of change, followed by your Individual NPI Number, Provider License Number/State, DEA Certificate Number, Medicare Number, and Medicaid Number. Each field is essential for identifying your practice.
Indicate whether you are accepting new patients and if you are an experienced HIV/AIDS provider. This helps streamline patient referrals.
For any changes in contact details or office addresses, clearly mark whether they are old or new. Include all relevant information such as street address, city, state, and ZIP code.
Complete sections regarding office hours and on-call physicians if applicable. This ensures that patients can reach you when needed.
Finally, ensure that the form is signed by the practitioner as no signature stamps will be accepted before submitting it via mail or fax to the appropriate address provided at the end of the document.

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Are all BCBS the same?

Blue Cross Blue Shield is NOT a Single Health Insurance Company. Rather, There are 36 Different Blue Cross Blue Shield Companies that are Part of as Association. Anthem is the Largest of all the Blue Cross Companies.

How many employees are at Excellus BCBS?

Collectively, the enterprise provides health insurance to nearly 1.5 million members and employs more than 4,000 New Yorkers. The company has financial strength rating of BBB+ (Stable) by Standard and Poors.

Is Excellus BCBS the same as BCBS?

New York. Excellus BlueCross BlueShield (Excellus BCBS, or Excellus) is a non-profit health insurance company headquartered in Rochester, New York. It is part of the Blue Cross Blue Shield Association. In 2010, Excellus was Upstate New Yorks largest nonprofit health plan.

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