Changes to staff/address/phone

Reporting most provider changes

To notify us of changes in your address, staff, tax ID number, or if you're opening or closing to new patients, follow these steps 60 days or more before the change takes effect:

  1. Log in to your prism account
  2. Click on Enrollments & Changes
  3. Select either Change Individual Provider or Change Provider Organization
  4. Follow the directions as indicated. For individual requests, submit a Provider Change Form. For multiple requests, submit a Provider Change Template.

The form must contain:

  • What's changing
  • The effective date of the change
  • Entity or tax ID number (EIN or TIN)
  • W-9, as applicable
  • NPI number and taxonomy designation (specialty type) that you'll be using for billing
  • If your request is to change the group information for a provider group, include the Type 1 NPIs of the impacted practitioners

Check the status of your request

Once you submit your request, our team will receive an inquiry. You can check the status of your request and view comments from our team any time in prism by clicking on Enrollments & Changes and selecting the Inquiry ID. When you request is completed, you'll receive a comment from our team. Any time our team posts a comment, you'll receive an email notification.

Reporting retirement/termination

At least 90 days prior to your retirement or termination of contract with Priority Health, notify us of the change. Learn how.