In order to best serve you and our members, it is important that we have up to date information about your practice. Please notify Sentara Health Plans as soon as possible of any changes related to your practice’s operations by submitting the appropriate update form.
Submit Provider Updates (Non-Delegated Providers)
This Provider Update form is intended for providers who are currently contracted with Sentara Health Plans or are in the contracting process.
Adding a new provider to your practice? Please review the provider credentialing requirements prior to submitting your Provider Update Form.
Changes affecting your Provider Agreement (contract)? Tax ID, Legal Business Name, product/reimbursement changes or other changes affecting your Provider Agreement (contract) cannot be submitted on this form. Please contact your Contract Manager directly or reach out to the Network Contracting team at 877-865-6075 for these requests.
Facilities or CMHRS/ARTs provider changes? Please contact your Contract Manager directly or reach out to the Network Contracting team at 877-865-6075 for these requests.
If your practice/organization (Tax ID) is out of network and interested in participating with Sentara Health Plans, please complete the “Request for Participation” form on the Join Our Network Page.
*The “Provider Update Form” is not intended for delegated providers.
Submit a Delegated Roster
Submission of the Delegation Update Form will initiate a request to review your delegated roster and process any new provider adds, changes, and/or terminations.
Your delegated roster must be attached to the Delegation Update Form using the format of the delegated roster template.If your roster includes a new Tax ID, please attach a W9 and contact your Sentara Health Plans Contract Manager in addition to submitting this form. Failure to do so may result in a delay in processing.
*The “Delegation Update Form” is not intended for Non-Delegated Providers