Urgent Reminder: Make Sure Your Provider Directory Information Is Accurate and Up-to-Date

Imagine you’re a new Highmark member who wants to find a network PCP. You look in the Provider Directory for a doctor who has been recommended by a friend. But the practice name can’t be found. Why? The practice name changed a few months ago, but it wasn’t updated in the Provider Directory. 

Lost opportunities like this one are just one reason why it’s vital that you update your information in Highmark’s Provider Directory. Our members use the Provider Directory to make informed decisions when selecting a provider. So, it’s to your advantage to make sure your directory information is correct and current.

Highmark is committed to ensuring the information in the Provider Directory meets our standards for quality. Therefore, please be aware that providers who do not validate their data will be immediately removed from the directory and their status within Highmark’s networks may be impacted.

The Centers for Medicare & Medicaid Services requires Highmark to conduct a quarterly outreach to validate provider information. We use this information to populate our Provider Directory and to ensure correct claims processing. Each review confirms:

• The practitioner name is correct. For example, we must ensure the practitioner’s name in the directory matches the name on his/her medical license.
  
• The practice name is correct. For example, is there a difference between the practice name that is being used when phones are answered versus the practice name listed in the directory?
  
• The practitioner’s specialties are correctly listed. Is there more than one specialty listed in the directory? Are both specialties being practiced?
  
• Practitioners are not listed at practice locations where they don’t actually practice. Practitioners listed must be affiliated with the group. Practitioners who cover on an occasional basis are not required to be listed. Practitioners who do not see patients on a regular basis at a location should not be listed at that location. 
  
• 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.

It’s vital that all providers review and update their information in NaviNet^®. Information should be updated as soon as a change occurs. All data should be reviewed at a minimum of once a quarter to ensure it’s 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 are currently making outreach calls to providers to verify the accuracy of provider data. If you receive a call, please provide our agent with the requested information.