NOTIFICATION OF CHANGE IN PRACTICE STATUS
Providers must immediately notify the VBH-PA Engagement Center in writing, to the attention of the Network Management Department, upon the occurrence of any of the following:
- Change of address, name change or merger, and/or new tax identification number. Please use either the “Address Update Form” or the “Request for Taxpayer Identification Number Form” when submitting the change. These forms may also be faxed to 1-855-541-5211.
- Revocation, suspension, restriction, termination, or voluntary relinquishment of any of the licenses, authorizations, or accreditations required by the VBH-PA agreement
- Any legal action pending for professional negligence which may reasonably be considered to be a material loss contingency, and the final disposition of the action
- Any indictment, arrest, or conviction for a felony or for any criminal charge related to an individual’s or a facility’s professional practice
- Any lapse or material change in professional liability insurance coverage;
- Restriction, suspension, revocation or voluntary relinquishment of medical staff membership or clinical privileges at any healthcare facility
- Any condition that results in temporary closure of a facility or office; or
- Outbreak of a serious communicable disease
VBH-PA recognizes that members have a basic right to privacy of their personal information and records. Access to member information lies solely with the member except in the case of a parent or guardian with legal custody of a minor child, or a person with legal authority to act on behalf of an adult or emancipated minor in making decisions related to health care.