Wellcare of Tennessee is committed to providing our providers with the best tools possible to support their administrative needs.
Providers are strongly encouraged to utilize this form to submit demographic updates.
Please fill out the form below with all necessary details, including all required documentation. When selecting the type of update, please review the critical requirements in bold to ensure accuracy in processing your request. Please also be aware that omitting necessary documentation may result in a delay in processing your request. Prior to completing the form, please review the following information:
- Requests to join our network are not processed using this form. To request to join our network or add a product to your existing agreement, please use our Join Our Network page.
- Please submit all claims and non-demographic update inquiries through our Provider Portal.
- This form does not process any changes to member data.
- This form is not intended to add a new practitioner to an existing group. To add a new practitioner to an existing, participating group, please download our Non-Delegated Credentialing template.
IMPORTANT NOTICE: Please consolidate all practitioner updates from your practice into a single submission. This form is exclusively for demographic updates. Claims, contracting and practitioner enrollment related-inquires must be submitted through their designated channels.
