Provider Change Request Form

Complete this form to change your Foundational Community Supports (FCS) provider. Please allow Wellpoint up to 5 business days to complete your request. In instances where a new provider is not assigned, additional processing time may be necessary due to limited providers with capacity.


For questions, please call FCS at 844-451-2828 (TTY 711) Monday through Friday from 8 a.m. to 5 p.m. Pacific Time or email at FCSTPA@wellpoint.com.