Provider / Practice Change Form

CIN provider/practice needing to make updates, please complete Mount Carmel Health Partners change form. If you have any questions concerning changes, please email Renee Sudimack of our Provider Relations team at This email address is being protected from spambots. You need JavaScript enabled to view it..

Just a reminder that when submitting provider information to Health Partners on the CAQH application you are certifying that all the information is current, true, correct, accurate and complete. This information is submitted to all payors to ensure timely and accurate claims processing and directory updates. Please review your CAQH information and update appropriately prior to submitting to Health Partners for initial credentialing or recredentialing. Your cooperation is greatly appreciated.

If you would like to update your provider information, please use this form.