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Provider Update

If you are a Beech Street provider (or office staff for a Beech Street provider) and wish to update the demographic information in your provider profile, please submit your information via facsimile, e-mail, or mail as noted below.  We apologize for any inconvenience, but our online submission process for demographic changes is temporarily unavailable.

The following data changes require written notification to our Network Operations department and must be submitted on your office stationery. The chart below outlines the different ways you can submit each change with these requirements.

Type of Change

Method of Submission Allowed

Facsimile:

866-241-1644

E-mail:

network.operations
@viant.com

Mail:
Provider Data Management, Beech Street Corp, PO Box 22968, Chattanooga, TN 37422

Tax Identification Number (TIN) name and number addition or change (Note: must include copy of W-9 form)

X

Only if you attach a scanned copy of the W-9 form

X

Tax Identification Number (TIN) removal

X

X

X

Retirement

X

X

X

Disenrollment

X

X

X

Deceased Provider

X

X

X

Malpractice changes on the malpractice face sheet

X

X

X


Thank you for helping us maintain accurate data.