Member PCP or Medical Group Change Request

I want to request a PCP change/Medical Group change.

Request Type: PCP change Medical Group change PCP and Medical Group change
Request Effective Date
Date must be in the future and must be the 1st of the month.

Agent Name Agent NPN Agent Email Address Agent Last 4 digits SSN Member First Name Member Last Name Member ID or Medicare Number Member DOB Member Email Address

PCP Name PCP Number 8 characters (e.g. 123456-A)

Medical Group Name Medical Group ID

To search for Provider ID or Medical Group ID, click here

Important Information:

* Please note changes may take up to 7 business days for completion. Members will need to be contacted by SCAN before certain changes are completed.
* Failure to choose a PCP/Medical Group with an open panel that is in network may result in denial of request and/or delay in services.
* Changing a member’s PCP will result in a new Member ID card being sent to the current mailing address on file.

Attestation:

* By clicking “Submit”, you attest that, as a licensed sales agent, you are requesting the above changes on the subject member’s behalf. You also attest that these changes were requested by the member, and that you have not and will not receive any compensation, inducement, or incentives for assisting the member with these changes.
* You further attest that, prior to submitting these changes, you have discussed them with the member and have received consent to request these changes on the member’s behalf.

Once you click Submit, you'll be redirected back to the Contact Us page.

Please click on the above Submit button only once.

Member PCP or Medical Group Change Request

I want to request a PCP change/Medical Group change.

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