Inform us of your practice changes
Choose the appropriate form below
| *Alternative medicine providers Chiropractors, Naturopaths, Massage Therapists and Acupuncturists | Email provider.updates@tivityhealth.com. |
| **Mental health providers | ONLY if you hold an active contract with Kaiser Permanente to provide outpatient mental health and substance use disorder services to Kaiser members and need to make updates to your practice demographics, please contact Magellan Healthcare at www.magellanprovider.com and update your practice information via their online Provider Data Change Form. Refer to your welcome letter from Magellan for your username and password. |
| 90-day notice is required. If we do not receive notice of your change within the 90-day required period, your change may not be reflected in our systems, including provider directory, claims, prior authorizations, etc. If you are enrolled in Electronic Funds Transfer you must also notify InstaMed of Billing NPI and Tax ID changes |
Terming a practitioner
Individual practitioner term form | Delegated Organizations/Providers:
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Adding an individual practitioner
| Individual practitioner add form | If you do not know if you are directly contracted with Kaiser Permanente, please reach out to your organization’s contracting department. Unsolicited requests may be declined if there is no business need. We have limited needs within our network for new contracts. Please review the following page: Contracting with Kaiser Permanente |