Provider demographic updates

Add, update or remove provider information

The form to request electronic funds transfer (EFT) changes is only accessible on the Availity Essentials portal.

Log in or create an account with Availity, then view the Resources tab in Blue Cross Blue Shield Minnesota Payer Spaces. 

The form is called "NEW-Electronic Funds Transfer (EFT) Form." Users must have access to the Minnesota Region on Availity in order to use the EFT form.

To reduce exposure to payment related fraud, Blue Cross will not approve new or updated electronic funds transfer requests received from providers that are not contracted (i.e., non-participating or out of network) with Blue Cross.

For more details, view QuickPoint QP112-20 Changes to Electronic Funds Transfer Processes

Allow up to 90 days for completion of this process.

Note: All entities that share the same NPI must have the same EFT information.

Complete the Tax ID Change form.

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809
El Paso, TX 79998-2809

Please allow up to 90 days for completion of this process.

Note: If you are not already contracted with Blue Cross Blue Shield of Minnesota under the Tax ID for the new location and are interested in joining our network, visit the Join our Network page.

If you are a healthcare provider:

Note: If you are not already contracted with Blue Cross Blue Shield of Minnesota under the Tax ID for the new location and are interested in joining our network, visit the Join our Network page

If requesting to change the existing contracted NPI to a new NPI/UMPI, see "Update NPI" lower on this page.

If you are a healthcare provider:

If you are not already contracted with Blue Cross Blue Shield of Minnesota under the Tax ID for the new location and are interested in joining our network, visit the Join our Network page.

If you are a healthcare provider:

How many practitioners do you have?

Five or fewer practitioners: When requesting a contract or new location, please submit the MN Uniform Practitioner Change form for each practitioner.

Six or more practitioners: If six or more need to be affiliated with the new location or contract, please fill out the Multiple practitioner add sheet (xlsx).

Where to send your forms?

Email the form to: provider.enrollment.and.credentialing@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please allow up to 45 days for completion of this process.

Complete an Individual PCA Data Sheet (Excel).

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please allow up to 45 days for completion of this process.

Complete the Tax ID Change form.

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809
El Paso, TX 79998-2809

Please allow up to 90 days for completion of this process.

Complete and submit the MN Uniform Practitioner Change form.

Email the form to: provider.enrollment.and.credentialing@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please allow up to 45 days for completion of this process.

The Non-participating Setup Request form is only to be used when requesting to be set up as a non-participating provider. This form is not to be used by contracted providers who are looking to become non participating. Please contact 651-662-5200 or 1-800-262-0820 if you have any questions.

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809
El Paso, TX 79998-2809

Please allow up to 90 days for completion of this process.

Please complete this form when a practitioner opts back into Medicare.

Medicare Opt-In Notification

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809
El Paso, TX 79998-2809

Please allow up to 90 days for completion of this process.

Complete and submit the MN Uniform Practitioner Change form. 

Email the form to: provider.enrollment.and.credentialing@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

For clinics changing their name, please fill out the Provider Demographic Change form

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
P.O. Box 982809
El Paso, TX 79998-2809

Please allow up to 45 days for completion of this process.

Complete a Provider Clinic/Branch Closure form. To ensure proper transition of care for impacted members, please provide at least a 60-day notice of a planned closure.

Email the form to: Provider.Data@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please note that if your clinic is changing your tax ID as a result of a merger/buyout, please see the answer to the question: “Add a location as a result of a merger/buyout.”

Complete and submit the MN Uniform Practitioner Change form.

Email the form to: provider.enrollment.and.credentialing@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Complete and submit the MN Uniform Practitioner Change form.

Email the form to: provider.enrollment.and.credentialing@bluecrossmn.com

Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please complete the Provider Demographic Change form.

Email the form to: Provider.Data@bluecrossmn.com
Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please allow up to 45 days for completion of the change process.

An updated NPI can be submitted by completing a Provider Demographic Change form for any contracting provider/facility or practitioner already set up on our system. (For new contracting providers/facilities or practitioners, the NPI should be entered on the initial request forms.)

Email the form to: Provider.Data@bluecrossmn.com
Or mail to:
Provider Data Operations
PO Box 982809 
El Paso, TX 79998-2809

Please allow up to 90 days for completion of this process.