Provider Data Change Request
Use this form to request changes to provider information found in Find a Doctor, Morrisey (credentialing) and Provider Relationship Management (PRM). Complete required fields, may leave other fields blank if they do not apply to your request. Providers are automatically added to Find a Doctor when their status is active in Morrisey.
If your request involves changes in EPIC you will also need to either contact the Help Desk at 248-853-4900 or via email email@example.com and request a ticket be opened for Epic.
This form does not replace HR functions related to hiring and terminating and does not update PeopleSoft or Kronos.