Verify and Update Your Information
When seeking health care services, our members often rely upon the information in our online Provider Finder®. As of Jan. 1, 2022, the federal Consolidated Appropriations Act (CAA) of 2021 requires that certain provider directory information be verified every 90 days.
Under CAA, we’re required to remove providers from our Provider Finder if the information isn’t verified. Learn more about CAA.
What to Verify
Verify your name, address, phone, specialty and digital contact information (website) every 90 days. It must be verified every 90 days even if your data hasn’t changed since you last verified it.
You must update your information when it changes, including if you join or leave a network. If you leave a network, continue to update your information immediately and according to your contract terms. If you are incorrectly identified as an in-network provider in Provider Finder, it may limit member cost-sharing to in-network levels.
How to Verify Information
Professional providers: We recommend using the Availity® Essentials Provider Data Management (PDM) feature to quickly verify your information with us and other insurers every 90 days. See our PDM page and user guide for more details.
Professional provider groups who submit changes by roster can verify all their providers’ information every 90 days with their roster. When a group submits a roster, all providers affiliated with this group and not listed with an update are verified as correct with no changes.
How to Make Updates
If you need to change your data, follow the instructions below. Updating your data will count as your 90-day verification. We won’t accept demographic changes by email, phone or fax to enable us to meet the two-day directory update requirement defined by the CAA. Any demographic updates requested through these channels will be rejected and closed. Changes 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.
Professional providers may update some data using the Availity Provider Data Management feature, including:
- Personal information
- Service location address change
- Payment address change and contact information
- Hours of operation
- Business website URL
Providers and facilities may continue to use the Demographic Change Form to update data, including:
- Legal name
- NPI/Tax ID
- Directory information:
- Office physical address
- Hours of operation
- Billing contact information
- Credentialing contact information
- Administrative contact information
- Provider roster information (removing a provider from the group or location)
If you have completed a Demographic Change Form, you can check the status of your changes by entering the case number you received in your confirmation email in our Case Status Checker.
Tax ID Termination Request
Contracted providers or groups (excluding Par Agreement) requesting a Tax ID termination from a provider network, please your Network Service Representative.
- You may specify more than one change within your request when all changes relate to the same billing (Type 2) NPI.
For the status of your professional contract application, or if you have questions, or need to make changes to an existing contract, please contact your Network Service Representative.