Verify and Update Your Information (2024)

When seeking health care services, our members often rely upon the information in our onlineProvider Finder^®.

You can verify and update certain data using the Availity^® EssentialsProvider Data Management featureor ourDemographic Change Form.Select the buttonsto access these tools.

Certain information must be verified every 90 days, and you must update your information when it changes. More details are below.

Verify Information Every 90 Days

The federal Consolidated Appropriations Act of 2021 requires that the following provider directory information be verified every 90 days: name, address, phone, specialty and digital contact information (website).

This data must be verified every 90 days even if it hasn’t changed since you last verified it.

Under CAA, we’re required to remove providers from displaying in our Provider Finder whose data we’re unable to verify. Learn more about CAA.

Professional, Facility and Ancillary* Providers

• Use the Availity Provider Data Management feature to quickly verify the required data every 90 days. PDM allows you to verify with multiple payers. See our PDM page and user guide for details.
• If you’re unable to use Availity, submit a Demographic Change Form to verify CAA requirements every 90 days. See our guide on using this form to verify data.

*Labs and dental care providers must use the Demographic Change Form rather than Availity PDM to update information.

Professional Provider Groups

• Groups can verify individual providers through Availity PDM or our Demographic Change Form.
• Groups who update their information 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.

Update Information When It Changes

Follow the steps below to update your data. Updating your data will count as your 90-day verification.

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 our provider directory, it may limit member cost-sharing to in-network levels.

We won’t accept demographic changes by email, phone or faxto 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.

Update with Availity PDM

Professional, facility and ancillary providers may use PDM in Availity to update the following data:

• Provider's personal information
• Service location address change and contact information
• Payment address change and contact information
  
• Hours of operation
• Languages spoken
• Business website URL

Update with the Demographic Change Form

Changes you can make using the Demographic Change Form include:

• Legal name for provider
• Provider hospital privileges
  
• Directory information:
  • Office physical address
  • Telephone
  • Fax
  • Email
  • Hours of operation
• New billing contact information
• Credentialing contact information
• Administrative contact information
• Provider roster information (removing a provider from the group or location)

Please indicate in the form comments section if you are adding or changing a location.

If you completed a Demographic Change Form, you can check the status of your application by entering the case number you received in your confirmation email in ourCase Status Checker.

If you need to add a provider to your current contracted group, complete theProvider Onboarding Form. Once the form and credentialing requirements are complete, we will appoint the provider into the network and send a letter to the contracted group. Credentialing can take 30 to 120 days.

Note:The CAQH Credentialing Application must be complete prior to completing the Provider Onboarding Form. Credentialing is required for Professional Provider Types: MD, DO, PSYD, DC, CNM, LCSW, LCPC, LMFT, DPM, PA, APN,CNP, RD, LAC and DN.

Additional Information Changes

Legal Name Change for Existing Contract
If you are an existing provider who needs to report a legal name change,complete a new contract applicationto initiate the update process.

Medical Group Change for Multiple Providers
If you are a group (Billing NPI Type 2) and have more than five changes, please send a request to IL Provider Roster Request to obtain a current copy of your roster to initiate your multiple change request.

For Medicaid, if your medical group would like to use the Government Medicaid Roster to submit provider updates, send a request to Government NetOps Provider Update.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsem*nt, representations or warranties regarding third party vendors and the products and services they offer.