To update your records by U.S. Mail, please just print the Update Your Records Form (PDF version - link below), fill it out completely and mail it to one of the following locations:
Pennsylvania 2060 East Ninth StreetMail Zone 01-6A-7509Cleveland, Ohio 44115-1355
Georgia 300 E Business Way, Suite 370Cincinnati, Ohio 45241
Provider Information Forms can also be obtained by contacting your Professional Contracting Representative.
Update Your Records Form, PDF version