It’s important to keep us up to date!
To meet Centers for Medicare & Medicaid Services (CMS) requirements, support claim accuracy and timely reimbursements, and provide our members with up-to-date information, all providers contracted with VillageCareMAX must keep their demographic information up-to-date.
- To submit a demographic change, please fill out this Provider Demographic Change Request Form, and email the completed form to [email protected] indicating ‘Provider Update’ in the subject line. (NOTE: If your Internet browser does not allow typing in the fillable form, you must download the form and use free Adobe Acrobat Reader software to complete it.)
- To submit a provider termination, please fill out this Provider Termination Form, and email the completed form to [email protected] indicating ‘Provider Termination' in the subject line.
Please submit changes and terminations at least 30 days prior to the effective date as changes may take up to 30 days to fully implement in the system.
If you need assistance or have any questions, please contact the Provider Relations department at [email protected].
