Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Blue Cross NC Home Providers Network participation Demographic and contact information Demographic and contact information
Changing provider and group demographic data

Complete this form when updating the billing, practice, and contractual notice demographic information for a group or solo provider. Email the completed form(s) to ProviderUpdates@bcbsnc.com or fax to 919-287-8884.

Complete a Change Form (PDF)(PDF)
Complete the change form

This page will explain the appropriate means to submit a demographic change request to Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

Requests can be emailed to ProviderUpdates@bcbsnc.com or faxed to 919-765-4349.

Normal processing time can vary between requests sent to Commercial or Blue Medicare. Average processing time will be from 10–30 business days. Complete provider details (e.g., name, NPI, IRS number, locations, Medicare number) and the effective date for the changes must be provided.

Notice: Incomplete requests will not be accepted for processing. Requests that are incomplete or are missing information will be returned to the sender. The request will need to be resubmitted with complete information to be processed. 

Change a practitioner's name

  • Submit a request on letterhead 
  • Provide a copy of updated medical license or copy of marriage certificate
  • Complete a new contract or amendment for solo providers
Change / add locations and addresses

  • Complete a demographic form or request on letterhead
  • Indicate where the address change applies: physical, billing, and / or contract notice addresses
  • Include a roster of all practitioners working at a new satellite location
  • Submit requests at least 30 days before to the effective date
Transfer a group practice

  • Completed a group enrollment application
  • Submit an updated W9
  • Submit individual enrollment applications for all practitioners who are not currently active in BCBSNC
  • Submit current medical license for practitioners who are not currently active in BCBSNC
  • Submit a new EFT form for participating groups
  • For contracted participating groups:
    • Current contract must support specialty of newly added practitioners
    • All practitioners must be credentialed (if applicable) to be enrolled
    • You may be required to sign a new contract amendment before making these changes, which may affect the effective date
  • Submit requests at least 60 days before to the effective date

If you have questions or need assistance, call 800-777-1643, opt 6.