Verify and Update Your Information
When seeking health care services, our members often rely on 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’re 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.
If you’re unable to use Availity, submit a Demographic Change Form. See our user guide on how to verify your data using the form.
Professional provider groups can verify individual providers through the Availity PDM feature or our Demographic Change Form.
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.
Facilities may only use the Demographic Change Form to verify and update data. See our user guide on how to verify information using the form.
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
- Directory information:
- Office physical address
- Telephone
- Fax
- Hours of operation
- Billing contact information
- Credentialing contact information
- Administrative contact information
- Provider roster information (removing a provider from the group or location)
If changing a solo practitioner to a group or starting a new solo practice, please use the onboarding form.
Dental Providers Participating in the Dental PPO Network should contact Dental Network Provider Administration (DNOA) at 800-972-7565 for all updates.
If you have questions, please email hcsx6100@bcbsmt.com.