Can New Patients Find Your Practice?

federal EmployIt can be extremely difficult for new patients to learn about your practice if you’re not listed correctly in the Highmark Provider Directory.

With Open Enrollment underway throughout Highmark’s footprint, you want to ensure that your provider information is accurate. Validating your information helps both new and current Highmark members to find and evaluate your practice when selecting a health care provider for 2024.

For example, if your address is incorrect, prospective patients may think your practice isn’t close to their home or work, and then opt for another provider.

Required Outreach

The Centers for Medicare and Medicaid Services (CMS) and the No Surprises Act require Highmark to conduct outreach to providers at a minimum of every 90 days to validate their provider directory information. Verifying your data consistently ensures accurate claims processing and allows members to make informed decisions regarding their health care needs based on the information in the provider directory.

Professional Providers – PDM Tool

Professional providers are now required to validate their Highmark Provider Directory information within the Provider Data Maintenance (PDM) tool in the provider portal — either Availity® NaviNet® — every 90 days. Reminder: Practitioners will no longer receive calls from Atlas or be able to use PrimeHub, Atlas’ provider data management software, to update information.

Please be aware that providers who don't validate their data quarterly may be removed from the Highmark online directory.

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 or team members answer the phone.
  • All specialties are correctly listed and are currently being practiced.
  • The practitioner’s address, suite number (if any), and phone number are correct.
  • Practitioners listed at a location currently see members and schedule appointments at that office on a regular basis.
    • Practitioners who cover on an occasional basis should not be listed.
  • The practitioner is accepting new patients — or not accepting new patients — at the location.

To learn more about the PDM tool, click here.

Facility, Ancillary, and Medicaid Providers – Atlas

The attestation process through Atlas is quick and easy. Just follow these steps…

  1. Go to hub.primeatlas.com.
  2. Log in.
  3. Review your information.
  4. If no changes, confirm.
  5. If there are changes, update your information.

If you haven’t attested your provider directory information this quarter, you will receive a letter from Atlas to review your provider information. Some providers may also receive emails from Highmark about validating their directory information through the Atlas website this quarter. To ensure delivery of emails from Highmark, please add the following email address, resourcecenter@highmark.com, to your address book.

If you need additional information regarding the attestation process, Atlas’ step-by-step guide is available on the Provider Resource Center.

 

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