Update your information

Here's how to let us know your name, address or other contact information has changed:

  • Physicians and other Individual Allied Health Practitioners located in Michigan must update demographic information online through the CAQH Universal Credentialing Datasource®. Visit the CAQH website for more information. Use the Enrollment and Change process to submit changes for network affiliations, participation, additional practice locations and other changes not available through CAQH.
  • Group Practices, Non-Hospital Facilities and other Non-Individual Health Care Providers located in Michigan: To change information about your group practice or business, use the Enrollment and Change process to submit the proper form.
  • Pharmacies: For questions related to Network Contracting and Management, Pharmacists and pharmacies should go to the Express Scripts website (Pharmacist Resource Center), or call Express Scripts at 1-888-571-8182. 

Fax or mail the completed form to Provider Enrollment and Data Management:

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Mailing address:
Provider Enrollment and Data Management

Blue Cross Blue Shield of Michigan
P.O. Box 217
Southfield, MI 48034
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Fax:
1-866-900-0250