Keeping Your Directory Information Current Is More Important than Ever

With the turn of the calendar to 2019, both new and returning Highmark members may be switching PCPs or looking for specialists. And they will be relying on Highmark’s online provider directory for accurate and current information about our network providers.

That is why it’s more important than ever to ensure that your practice information on file with Highmark remains up to date. We use this information to populate our provider directory and to help ensure correct claims processing.

IMPORTANT NOTE: Please be aware that providers who don't validate their data will be immediately removed from the directory, and their status within Highmark’s networks may be impacted.

Reviewing data is vital for you

The Centers for Medicare & Medicaid Services (CMS) requires Highmark to reach out to you every quarter and ask you to validate your provider information.

Your thorough review of your directory information confirms:

• Each practitioner’s name is correct and matches the name on his/her medical license.
• The practice name is correct and matches the name used when you answer the phone.
• All specialties are correctly listed and are, in fact, currently being practiced.
• Practitioners listed at a location actually see patients and schedule appointments at that office on a regular basis. All practitioners listed must be affiliated with the group. (Practitioners who cover on an occasional basis are not required to be listed.)
• The practitioner is accepting new patients — or not accepting new patients — at the location.
• The practitioner’s address, suite number (if any), and phone number are correct.

 

Change happens

It’s vital that you review and update your information as soon as a change occurs. Go to Provider File Management within NaviNet^® to check these fields:

• Current address
• Phone number
• Fax number

Remember to review your data at least once a quarter to ensure it is accurate.

Detailed instructions are available in the Provider File Management NaviNet Guide, which is available on the Provider Resource Center under Education/Manuals.

Highmark and its designated agent, Atlas, are currently making outreach calls to providers to verify the accuracy of provider data. If you receive a call, please help our agent to gather the right information.