Provider Update Request Form - Virginia Premier

Provider Update Request Form

Are you already a participating provider/group with Virginia Premier and need to notify us of updates or changes to your office or provider information (i.e. terminations, address or phone number change/update, additional providers or locations to be added)? Please use this page to submit changes to Virginia Premier. You may validate the completion of your request 15-20 business days after submission via the Virginia Premier Online Provider Directory and/or the Online Provider Portal, as applicable.

Note: Please submit Tax ID change requests via: networkdevelopment@virginiapremier.com. If you have questions on how to submit a request or if you are submitting a request where the update is applicable to more than 10 providers please email vphpcontractingpdm@virginiapremier.com. Any other requests will be directed back to the Provider Update Form.

Note: Please make sure your CAQH information is updated prior to submitting this request. If your CAQH information does not align with your request, your request will be returned causing delays in progressing.

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