Report a Problem

Have you found any inaccurate data on Find a Provider? Use this form to help us ensure that the Provider data on our Find a Provider tool is accurate.

If you would like to submit this information by phone, or if you have any questions please contact us at:

Phone: 1-877-644-4613

Required fields are marked with an asterisk (*)

Are you a Provider, Member or Other Party? * Member or Other Provider

What is the Provider's name? *

What is the Provider's phone number?

Find an error? Report it here. *

This form will send your message to Coordinated Care as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with Coordinated Care through email, you accept associated risks. Coordinated Care does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your PHI, please send us a message through the Secure Member or Provider portal.

Name of Person Filling Out the Form *

Position Title of Person Filling Out Form *

Is all your information in our system currently correct? * Yes No

Provider Name *

Are you validating or reporting information for an entire group or a single practitioner? * Entire Group Single Practitioner

Provider Phone Number *

Provider Email Address *

Provider Address * Ex. 123 Test Street Cityname, State 12345