Want to modify your demographic information or add/remove a provider?
iCare makes it easy for providers to update this information.
Contracted providers wanting to modify their demographic or affiliation information can do this by filling out the applicable form below. Instructions are included on each form.
Name, Tax ID, Physical or Billing Address Changes:
Demographic Change Form - Print/Fax back
Demographic Change Form - Electronic
Adding or removing providers associated with a contracted provider group:
Affiliation Change Form - Print/Fax back
Affiliation Change Form - Electronic
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