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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

Update Member Assignment Limitations

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

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

Practitioner Name

Service Location Address

Practitioner Type required *
Is Practitioner Accepting New Members? required *

Update Requested By

Choose All Applicable Networks required *

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

Primary Care Provider (PCP) Name

All fields are required.

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)

Service Location Address

Update Requested By

Choose All Applicable Networks required *

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

Primary Care Provider (PCP) Name

All fields are required.

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 02/04/2021)

Service Location Address

Practitioner Type required *

Update Requested By

 

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