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Requirements for Updating Provider Directory Information
The Consolidated Appropriations Act (CAA) was signed into law in 2020 to provide relief legislation in response to the coronavirus pandemic. Under one of the provisions in the CAA, Blue Cross and other health plans are required to verify provider directory information every 90 days beginning in 2022. Updated practice information allows us to provide patients with current practice and provider information to assist them with selecting the most appropriate providers for the care they are seeking.
Provider Responsibilities Under the CAA
Providers have responsibilities under the CAA to comply with these requirements. These include:
- Verify your directory information every 90 days.
- Update your information when it changes. This would include name, address, specialty, phone number and digital contact information.
- If you are newly enrolled in or leave a network, please update your directory information immediately.
Confirm Directory Information Through VerifyHCP®
As announced in November 2021, Blue Cross has partnered with LexisNexis® Risk Solutions, an independent company, to make it easy for you to confirm and verify information for our provider directory. LexisNexis' VerifyHCP solution allows practices to validate or update their information in one place for all participating health plans.
Potential CMS Provider Directory Information Audit Questions
The following questions may be asked during a CMS Provider Directory Information Audit:
- Does the provider see patients at this location?
- What is the address?
- Does the provider accept a Medicare Advantage Prescription Drug (MA-PD) plan at this location?
- Does the provider accept new patients who have this MA-PD plan? (The provider directory is considered accurate if it correctly indicates the provider is or is not accepting new patients.)
- Is the provider a primary care physician, cardiologist, oncologist, or ophthalmologist?
- What is the telephone number for making appointments? (Usually confirmed by dialing the phone number.)
- What is the provider's name?
- What is the practice name?
Use this printable version of the potential questions to prepare your office staff.
Respond to Provider and Practice Outreach
LexisNexis is reaching out directly to individual providers and practice administrators to confirm and update directory information. Outreach methods include email, fax and phone, with email being the primary method. Providers or practice administrators will be asked to complete a simple initial registration process for the VerifyHCP portal in order to log in and confirm directory information. The VerifyHCP portal is secure and free for clinicians and their staff to confirm directory information, as required by CAA, CMS and various state laws.
If LexisNexis contacts you, please respond promptly. Clinicians who do not respond to verification requests may face delayed claim reimbursements and removal from provider directories.
If you have questions, email us at Credentialing@bcbsal.org.
LexisNexis is an independent company that provides products and services including VerifyHCP.