CHPW is committed to ensuring the quality and accuracy of the information in our provider directory for our Medicare and Medicaid (Washington Apple Health) products. The Add Change Term forms are used to notify us of changes in your information including, but not limited to:
- Tax identification number
- Billing address
- Office phone and fax numbers
- Service location address updates
- Areas of expertise
CHPW’s new Provider Add Change Term (for individual providers) and Clinic and Group Add Change Term online forms are now available on our website.
The online forms are easy to use and easy to submit. You can click in a field to enter or select information or you can press the Tab key to move from field to field. After you fill in your information, click the Submit Form button at the bottom of the form. If any required fields are missing information or the form has any errors, you will receive a message indicating what needs to be fixed.
The Excel versions of the Add Change Term forms are still available, and we recently added PDF versions. You may use an online, PDF, or Excel form to update your information with us. If you use an Excel form, please use the Chrome browser. The forms can be accessed from the HealthMAPS provider portal.