Verify and Update Your Information

When seeking health care services, our members rely on the information in our online Provider Finder®.

You must update your information when it changes, including if you join or leave a network. Your provider directory information must be verified every 90 days, even if it hasn’t changed since you last verified it.

More details are below on tools to verify and update your information, as well as state and federal requirements. If you have questions, contact your network representative.

Verify Your Information Every 90 Days

Certain directory information must be verified every 90 days to fulfill New Mexico requirements and the federal Consolidated Appropriations Act of 2021.

What to verify: Your name, address, phone, specialty, digital contact information (website) and whether you are accepting new patients.

The provider directory includes the most recent date information was verified. If the information hasn’t been verified within the past 90 days, the directory will reflect this.

You may receive an email reminder from us with a link to verify your details or other outreach to verify your information.

Under CAA, we’re required to remove providers whose data we’re unable to verify from displaying in our directory. 

Update Your Information When It Changes

You must update your information when it changes, including if you join or leave a network. If you leave a network, update your information immediately and according to your contract terms. If you’re incorrectly identified as an in-network provider in our provider directory, it may limit member cost-sharing to in-network levels.

Changes to your information must be submitted electronically unless you have otherwise opted out of conducting business with us electronically; in that case, changes will be accepted by U.S. mail.

More details are below on options to update your information.

  • Update by Demographic Change Form: All Providers

    Groups, solo professional providers and facility and ancillary providers may use the Demographic Change Form to update data when it changes. Labs and dental providers must use the Demographic Change Form to update information.

    Changes you can make using the form:

    • Provider’s personal information
    • Legal name for rendering provider
    • Provider hospital privileges
    • Service location address and contact information, including phone, fax, email (indicate in the form comments section if you are adding or changing a location)
    • Website URL
    • Hours of operation
    • Language spoken
    • Billing contact information
    • Credentialing contact information
    • Administrative contact information
    • Provider roster information (removing a provider from the group or location)

    You may specify more than one change within your request when all changes relate to the same billing (Type 2) NPI.

    If you completed a Demographic Change Form: You can check the status of your update by entering the case number you received in your confirmation email in our Case Status Checker.

  • Update by Availity Essentials: Professional, Facility and Ancillary

    Professional and most facility and ancillary providers may update some information in the Provider Data Management feature in Availity Essentials. Labs and dental providers must use the Demographic Change Form rather than PDM to update information.

    Changes you can make in PDM:

    • Provider's personal information
    • Service location address change and contact information
    • Payment address change and contact information
    • Hours of operation
    • Languages spoken
    • Business website URL

  • Update by Roster: Delegated and Approved Behavioral Health Roster Groups

    Delegated and approved behavioral health rostered groups may update information by submitting a roster. Submitting a complete, updated roster also satisfies 90-day verification requirements.

  • Updates to the National Provider Identifier Registry

    If you have a National Provider Identifier: When your information changes:

    1. Update the Centers for Medicare & Medicaid Services’ National Provider Identifier Registry
    2. Update us using one of the tools above

    Refer to the National Plan & Provider Enumeration System FAQs and CMS for more information.

  • Other Updates or Questions

    Contracted providers or groups (excluding Par agreement) requesting a Tax ID termination from a provider network: Contact your Network Representative.

    For the status of your professional contract application, or if you have questions or need to make any other changes to an existing contract: Contact your Network Representative.