Updating provider information

To ensure that you receive timely payment for approved medical treatments and other information, you must keep your provider enrollment information up to date. BWC and managed care organizations use this information regularly.

To change provider enrollment information, complete the Request to Change Provider Information (MEDCO-12) or submit the changes in writing and on letterhead to:

Ohio Bureau of Workers’ Compensation
Provider Enrollment Unit
P.O. Box 182031
Columbus, OH 43218-2031

You also can fax your changes to (614) 995-2249.

When requesting a change to your provider enrollment data, please provide the following information:

• Provider name and 11-digit BWC provider number;
• Telephone number;
• Signature of person who is assigned to the specific provider number;
• For address changes – physical address, pay-to address and correspondence address.

You also must request changes to tax identification numbers and group affiliations in writing. Include when the changes become effective.