 change in practice information
CNC Providers are contractually required to notify CNC, within 15 days, of any change to your practice information. Failure to adhere to this policy may result in termination from the network. Changes must be submitted within 15 days of the occurrence/change and must be submitted to CNC in writing.
Such changes include but are not limited to:
- Change of practice address including addition of Satellite Office,
- Phone/Fax Number
- Tax Identification (requires updated, completed W-9 form)
- Billing- Administration changes
- Practice Name (requires updated, completed W-9 form)
- Additions or deletions of providers in the practice
- Any action(s) by the State Chiropractic licensing Board, CIN-BAD, Medicare/Medicaid or any action that could affect your license to
practice chiropractic.
9. Any change in your malpractice insurance information including notice of
any claims filed against you.
Please use the CNC Provider Change Form to notify CNC of any changes and attach additional pages, as needed. Please indicate the effective date of change.
PLEASE DO NOT SUBMIT ANY CHANGES TO THE MANAGED CARE PARTNERS WITH WHOM WE CONTRACT. CNC WILL INFORM OUR MANAGED CARE PARTNERS OF ANY CHANGES INVOLVING A CNC PROVIDER.
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