Provider demographic and/or practice changes

Use the links below to submit changes or updates to your provider information. Your timely submission of these updates allows us to maintain an accurate provider directory.

Alternative medicine providers

If you are an alternative medicine provider and need to make updates to your demographics or contract, contact WholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC, at 1-800-274-7526 or email provider.updates@tivityhealth.com.

Mental health providers

If you provide outpatient mental health and substance use disorders services 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.



Add
practitioner(s)

If you are already contracted and adding a practitioner or you are moving a practitioner from one care site to another within your group, contact your Provider Service Consultant or email kpwa.provider-services@kp.org if you do not know who your Consultant is.
Provider demographic and business updates

Use this link for:

  • Clinic/services location updates
  • Close a clinic location
  • Remit/billing "Pay to" address updates
  • Tax ID update / Tax ID address update / 1099 address update

Term
practitioner(s)

 

  • Please ensure that prior to submission, verification is done to clarify whether a practitioner is being termed entirely from the organization/tax ID or only from a care site/clinic(s).
  • Primary care practitioner terminations will require the name of the practitioner within the clinic/organization to whom the patient panel will be transferred to enable us to complete the panel transfer in our systems.

If your clinic is listed below, please contact your credentialing specialist to make these changes. We will not term the practitioner, as we must follow the standardized process of roster notification.

  • Children's University Medical Group
  • Evergreen Health
  • Franciscan Medical Group/Franciscan Health Systems
  • Harborview Medical Center
  • Kadlec Regional Medical Center
  • MATRIX Medical Network
  • Memorial Physicians, PLLC (dba Yakima Valley Memorial Hospital)
  • MultiCare Health System
  • MultiCare Rockwood Clinic
  • Northwest Hospital & Medical Center, UW Medicine
  • Northwest Rehab Alliance
  • Pacific Medical Centers (PacMed)
  • PeaceHealth Medical Group
  • Polyclinic
  • Proliance Surgeons
  • Providence Health & Services – Washington
  • Skagit Regional Clinics/Skagit Valley Hospital
  • St. Luke's Rehab Institute
  • Swedish Health Services
  • Tivity / WholeHealth Networks, Inc.
  • University of Washington Physicians
  • Valley Medical Center
  • Virginia Mason Medical Center
  • Walla Walla Clinic
  • Western Washington Medical Group
  • Yakima Valley Farm Workers

Reminders

  • If you are enrolled in Electronic Funds Transfer you must also notify InstaMed of Billing NPI and Tax ID changes by emailing support@instamed.com or contact InstaMed Customer Service toll-free at 1-877-833-6821.

  • Your Tax Identification number (either an EIN or SSN) is used for billing purposes. If your tax ID or business name changed, we’ll need an updated W-9 to ensure the IRS is properly notified.