Provider updates
WEA Trust members utilize our provider directories to locate providers within our networks. As a current Trust provider, keeping your listing current and accurate is vital for your communication with Trust members.
Please use the forms below if there has been a change in your organization, practice, contacts, location, or practitioners. This notifies us to update your profile in our listing directories.
* If you are not currently a WEA network provider and would like to apply, please visit our Network application page.
Organization/business practice & service location update form
Use this form to report any changes to your organization's information including:
- Organization or business name
- Tax ID
- Address or location
- Billing information
- Contact information
- Phone/fax numbers
Organization Provider Update electronic form – Select this option if you have four or less service locations and 20 or fewer practitioners, and have Microsoft Word. If you don't meet these criteria, please use the .pdf form below. Selecting this option will open a Word form. Electronically enter your information, print and mail.
(The tab key will move you between form fields. Press the spacebar to select a check box.)
Organization Provider Update .pdf form – Select this option to print the form, enter your information, and mail.
Individual practitioner update form
Use this form to report changes for individual practioners. Use one form for each practitioner. Updates may include changes in: - Practitioner specialties
- Practitioner service locations
- Practitioner effective or term dates
- Practitioner name or contact information
Individual Provider Update electronic form – Select this option if you have four or less service locations affected by an individual's change, and have Microsoft Word. If you don't meet these criteria, please use the .pdf form below. Selecting this option will open a Word form. Electronically enter your information, print and mail.
(The tab key will move you between form fields. Press the spacebar to select a check box.)
Individual Provider Update .pdf form – Select this option to print the form, enter your information, and mail.
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Return your forms by fax or mail.
Attn: Provider Information Manager
WEA Trust
P.O. Box 7338
Madison, WI 53707-7338
Fax: (608) 276-9119
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