Provider Directory Locations – CMS Guidance

Attention Providers - It is important to our members that your practice location(s) listed in our Provider Directories are where you regularly see patients. In this regard, the Centers for Medicare and Medicaid Services (CMS) guidance states, “For group practices, directories must only list individual providers at locations where they routinely see patients, as opposed to every location of the group practice. Plans may not include providers in their directory that serve as an on-call or substitute provider and who are not regularly available to provide covered services at an office or practice location.”

Provider directory accuracy is important to us because it is important to our members. To align with CMS guidance and in furtherance of improving directory accuracy, we are currently reviewing our provider directory data and may be reaching out to providers with a large number of practice locations listed to determine if individual providers are regularly seeing patients at all listed locations or make system updates, if needed. We encourage you to review your directory data and submit any address updates via Availity or through the online Provider Web Demographic form. Please contact your Provider Representative using the contact list if you have any questions or need assistance with the tools mentioned.

We appreciate your continued support of our members and our goal of providing them with accurate directory information to assist them in finding the care they need.