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

When you’re shopping for an item online, you assume that what’s displayed on the retailer’s site is in stock and ready to ship. It can be both disappointing and frustrating to learn that the item you seek is no longer available.

When it comes to health care, consumers have even greater expectations. They assume that when they are looking for a primary care physician or specialist, the provider directory on their health plan’s website has practice information that is accurate and up to date.

That’s why it’s essential that your practice information in our Provider Directory is current and correct.  

Highmark is committed to ensuring that the information in our 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 practicing 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 schedule appointments and see patients. 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.

Note: Your up-to-date information must include your current address, phone number, fax number, and any and all required data elements set forth in the provider contract(s) with Highmark.

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, Atlas, 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.

Note About Lactation Services

Does your practice offer lactation counseling services? If so, you need to update your provider directory information in NaviNet to let our members and your potential new patients know about the services you deliver. To confirm or update your information:

  • Select Provider File Management.
  • Select Practice Location to edit.
  • Expand Office Accessibility and Services.
  • Click Edit on Services Offered at this Location.
  • Select the box that reads Lactation Counseling, and then click Submit.

 

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