Healthfirst Individual Practitioner Roster Form

Posted Apr 23, 2026

Keep Your Provider Information Up to Date

Use the Individual Practitioner Roster form to report updates to your individual practitioner provider information, including service address, phone number, participation status, and more.

 

Accurate provider information helps ensure members can find and access care, keeps directories current, and supports timely, accurate payment for your services.

Providers must notify Healthfirst of any changes to their provider record or participation status at least 30 days before the effective date.

Roster Template
Submit Provider Updates
  • Non-Delegated Providers: Send updated rosters to your Network Account Manager
    • Not sure who your Network Account Manager is? Call Provider Services at 1-888-801-1660 (Monday–Friday, 8:30am–5:30pm). Have your Tax ID Number (TIN) ready, and we’ll connect you to the right contact.