Providers – Please Verify Your Information Every 90-Days and Update Your Information, As Appropriate
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.
Additionally, the State of New Mexico requires information to be verified by providers every 90 days, including provider panel status ‘Accepting New Patients’. The online provider directory now reflects the most recent date this specific information was verified, or if not verified within the past 90 days, that will be shown in the directory and may result in increased inquiries to the provider office.
What to Verify
Verify your name, address, phone, specialty, digital contact information (website) and Accepting New Patient status every 90 days. It must be verified every 90 days even if your data hasn’t changed since you last reviewed 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 timely 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 verifying data by utilizing the link sent to a valid email address on your BCBSNM provider data file 45 and 60 days after you last updated your data with a reminder to verify your data. The link sent will connect you to a secure site that allows you to verify all data elements, including ‘Accepting New Patients’. If you have not received the link or would like to have it re-sent to you please contact your Provider Representative, as found on the Network Contact List, to validate your service email and the link can be re-sent.
Alternatively, you can use the BCBSNM online Demographic Change Form. See our user guide on how to verify your data using the form. This form is primarily used to make changes to your data but can also be used to verify information accuracy.
Providers may additionally, use the Availity® Essentials Provider Data Management (PDM) feature to quickly verify your information with us and other insurers every 90 days. Unfortunately, the required element ‘Accepting New Patients’ cannot be verified using the tool at this time.
Professional provider groups must verify individual providers through the tools outlined above. 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 your information using the form.
How to Make Updates
If you need to change your data, we recommend using the Demographic Change Form following the instructions. 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. 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. Once 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.
Reminder
- You may specify more than one change within your request when all changes relate to the same billing (Type 2) NPI.
A limited list of data can be alternatively updated by professional providers only via 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
All other changes, or changes at the group or facility level must be completed using the Demographic Change Form.
Other Requests
Contracted providers or groups (excluding Par Agreement) requesting a Tax ID termination from a provider network, please contact your Network Service 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, please contact your Network Service Representative.