Provider Update Form

Providers who are currently participating in a HealthSmart network can update their basic provider information by completing and submitting the form. To access the form, CLICK HERE or click on the form image at right. Please use this form if you are a provider with one or more of the following HealthSmart networks:

  • ACCEL Network
  • HealthSmart Preferred Care
  • HealthSmart Payors Organization (HPO)
  • Workers Compensation
  • Auto Medical Network
  • HealthSmart Dental Network

It is important to notify HealthSmart of any provider changes no less than 30 days prior to the change. Provider changes include:

  • New practice name
  • New office location or phone number
  • Tax ID Changes (W9 required)
  • Providers leaving a group

If your practice is adding a new provider to your group contract, please contact us to request an application for participation.

Our Provider Relations team may contact you to verify the information on this form prior to updating your records in our system. Please allow up to 30 business days before your changes are reflected in our Provider Lookup. Once you complete the form, you can mail a hard copy to the address below, send a digital copy to the email below or fax your completed form.


HealthSmart Network Solutions
Attn: Provider Relations
222 West Las Colinas Boulevard, Suite 600N
Irving, TX 75039





Please note that if a provider is adding a new certification, the Provider Data team will forward the submission to our Credentialing department, who may require additional information including certificate copies or other paperwork.