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Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how

Address Change

What would you like to do?
Choose All Applicable Networks required *

If submitting for specific WellCare product(s), indicate applicable products in Comments section

Facility Name

If Facility based / Ancillary provider, please download the Meridian Facility Application (PDF) and attach it in the upload field. The Meridian Facility Application is applicable in circumstances where there is a Group NPI update and a service location update coinciding.

Practitioner Name

If multiple practitioners' provider updates are needed, please download the Meridian Roster Template and attach it in the upload field. All roster fields are required.

Meridian Roster Template (Excel)
(Roster template revised 02/04/2022)

Old Service Location Address

New Service Location Address

Is the address change for a primary location? required *
Should this location be supressed in the directory? required *
Is your billing address also changing? required *

Office Hours

Update Requested By

Should this location be suppressed in the directory? required *
Choose All Applicable Networks required *

If submitting for specific WellCare product(s), indicate applicable products in Comments section

Facility Name

If Facility based / Ancillary provider, please download the Meridian Facility Application (PDF) and attach it in the upload field. The Meridian Application is applicable in circumstances where there is a Group NPI update and a service location update coinciding.

Practitioner Name

If multiple practitioners' provider updates are needed, please download the Meridian Roster Template and attach it in the upload field. All roster fields are required.

Meridian Roster Template (Excel)
(Roster template revised 02/04/2022)

Office Hours

Additional Location Address

Is your billing address also changing? required *
Should this location be supressed in the directory?

Update Requested By

Choose All Applicable Networks required *

If submitting for specific WellCare product(s), indicate applicable products in Comments section

If multiple practitioners' provider updates are needed, please download the Meridian Roster Template and attach it in the upload field. All roster fields are required.

Meridian Roster Template (Excel)
(Roster template revised 02/04/2022)

Practitioner Name

Delete Location Address

Update Requested By

Choose All Applicable Networks required *

If submitting for specific WellCare product(s), indicate applicable products in Comments section

Current Billing Address 

New Billing Address 

Update Requested By

 

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