Great Lakes Health Connect values your partnership in building care-connected communities. Together we strive to improve health outcomes and healthcare value for patients, providers, and payers across Michigan and beyond. In achieving this goal, protecting patient health information must be a top priority. Therefore, keeping us well-informed of provider changes in your office is crucial to ensuring that the right information gets to the right place at the right time.

The Provider Update Request process has been enhanced to meet the needs of our growing community. The Provider Update Request User Guide (revised 03/23/2017) provides instructions on how to access and complete the form.

Instructions:

  1. How many Providers need to be updated?
    • One – Three: The requester should complete the on-line form below.
    • More than Three: The requester should download the excel version of the Provider Update Request Form (revised 03/23/2017) and send it to support@gl-hc.org.
  2. Find relevant provider codes

Forms that are missing required information will be returned to the requester.

Immediate change requests will be processed within 3 business days. GLHC will inform all applicable hospitals of your provider changes.

If you have any questions, please contact your local Implementation Consultant or GLHC Support at support@gl-hc.org or at 844-454-2443, option 2.


  • Example: Practice Manager, Office Manager, Administrator
  • No abbreviations
  • Last Name*First Name*Middle Initial*Credentials*National Provider Identifier (NPI) (*ADT Notifications and Direct)State License Number (*Direct)EMR Provider Code (*Results delivery into your EMR)Specialty or Specialties (*Referrals)Start DateEnd Date 
    Add a row
    Note: Fields will expand as text is entered. To add another line click the plus sign on the right. Only one date field is required, estimate if needed.
  • This field is for validation purposes and should be left unchanged.