Verify and Update Your Information
When seeking health care services, our members often rely on the information in our online Provider Finder®. Beginning Jan. 1, 2022, the federal Consolidated Appropriations Act (CAA) of 2021 requires that certain provider directory information be verified every 90 days.
This means that starting Jan. 1, 2022, you must:
- Verify your name, specialty, address, phone and digital contact information (website) for our provider directory every 90 days, and
- Update your data when it changes, including when you join or leave a network
Under CAA, we’re required to remove providers from our Provider Finder whose data we’re unable to verify.
If you leave a network, you should 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. Learn more about the CAA.
How to Verify and Update
We recommend professional providers use the Provider Data Management feature to quickly verify and update information. If you’re unable to use Availity, you may submit a Demographic Change Form . 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.
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.
Changes professional providers can make in theProvider Data Management feature include:
- Personal information
- Service location address change
- Doing Business As (DBA) name
- Payment address change and contact information
- Hours of operation
- Business website URL
Changes providers and facilities can make using the Demographic Change Form include:
- Legal name
- 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 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 firstname.lastname@example.org.