Change of provider form 60193: Fill out & sign online

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Click ‘Get Form’ to open the bluecross information change request form in the editor.
Begin by checking the appropriate boxes under 'TYPE(S) OF CHANGE' to indicate what changes you are requesting, such as provider name or billing location.
In the 'YOUR EXISTING INFORMATION' section, fill in your current details as they appear on file with BCBSIL, including your legal name, practice name, and contact information.
Proceed to 'CHANGE DETAILS/UPDATE YOUR INFORMATION' where you will enter the new information for each section that requires an update. Be sure to provide complete addresses and contact details.
Complete the 'ATTESTATION' section by signing and dating the form to certify that all provided information is accurate.

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Is Blue Cross Blue Shield valid in other countries?

As a Blue Cross and Blue Shield member, you take your healthcare benefits with you when you are abroad. Through the Blue Cross Blue Shield Global Core program, you have access to doctors and hospitals around the world.

How do I change my name with Blue Cross Blue Shield?

Direct policyholders should request your name change through the agent that issued your policy. Find contact info for your local BCBS company online at .

Can I use my US health insurance in another country?

Yes, your Service Benefit Plan coverage protects you around the world. Benefits for covered services under FEP Blue Focus, FEP Blue Basic and FEP Blue Standard paid at the Preferred level.

Does BCBS Basic cover international travel?

Through the Blue Cross Blue Shield Global Core program, you have access to doctors, hospitals and other health services in nearly 200 countries and territories around the world. Call the Service Center in these situations: You need to locate a doctor or hospital or need medical services.

il bluecross blueshield information change

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Bluecross information change request form 2026

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Is Blue Cross Blue Shield valid in other countries?

How do I change my name with Blue Cross Blue Shield?

Can I use my US health insurance in another country?

Does BCBS Basic cover international travel?

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Bluecross information change request form 2026

Here's how it works

How to use or fill out bluecross information change request form with our platform

See more bluecross information change request form versions

Complete this form in 5 minutes or less

Got questions?

Is Blue Cross Blue Shield valid in other countries?

How do I change my name with Blue Cross Blue Shield?

Can I use my US health insurance in another country?

Does BCBS Basic cover international travel?

il bluecross blueshield information change

Security and compliance

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