Accurate provider directories are essential for members to use as a resource tool in making informed health care decisions and for receiving timely access to care.
The Consolidated Appropriations Act (CAA), 2021, effective January 1, 2022, requires health plans to establish a process to verify and update provider directory information at least every 90 days. Providers are required to have in place processes to ensure the timely provision of provider directory information to support the health plan’s compliance with CAA requirements. Having accurate provider directory information is also a requirement for compliance with the Centers for Medicare & Medicaid Services (CMS), the Affordable Care Act (ACA) and your agreement as a network provider for BridgeSpan patients.
Note: Providers whose contract status has lapsed more than 30 days will be required to resubmit an initial credentialing application. Not having an active practice location is considered a lapse.
We require the following:
- Providers must continue to review to verify accuracy and submit all updated information about their practice at least every 90 days. In compliance with the CAA, we have defined our policy to require provider verifications every 90 days.
- Providers must notify us promptly of changes to directory information. Validate your practice information today by following the steps below.
- All participating providers who are eligible to display in directories based on their specialty and current credentialing status will be displayed in our provider directories.
- All participating providers are required to comply with our policies and procedures related to furnishing information necessary to ensure provider directories are up-to-date, accurate and complete pursuant to federal and state law, including 45 C.F.R. 156.230(b). This information includes, but is not limited to, accepting new patients, provider practice location, contact information, specialty, medical group and other institutional affiliations.
- Providers must review, update and return roster validation requests from us.
- Failing to verify directory information is grounds for removal from our provider directory and/or termination of the provider’s agreement with us.
A provider is removed from our directory in the following scenarios until such time that the provider properly verifies or updates their directory information:
- Research results in inability to verify a provider’s directory information based on the most recent information from the provider, internet research, claims data submitted, an out-of-service phone number or failure to reply to voice messages or email;
- Research based on member feedback of invalid contact information that we are unable to verify or update; or
- When notified of a provider’s retirement, move out of area or death.
Follow these steps to verify and attest to the information about your practice and the networks you participate in at least every 90 days:
- Visit Find a doctor from any page on our website.
- Type the provider's last name, first name in the search field.
- Verify demographic information for each location.
- Verify whether the provider is accepting new patients or offering telehealth services at each location. If you are a behavioral health provider, please verify your areas of focus.
- Confirm that patients may make appointments to be seen at each location listed for that provider.
Select the link for Networks Accepted to verify which networks apply for each provider at each location.
If your information is correct, you do not need to do anything else at this time.
Please let us know immediately if anything is incorrect or any of the following have changed by calling our Provider Contact Center:
- Phone number
- Organization's address
- Accepting new patients
- Offering telehealth services
- eContracting email address
- Changing organization ownership
- Practice data validation email address
- National Provider Identifier (NPI) number
- Providers joining or leaving your clinic or practice
- Changing where your payments should be directed
Changing your tax ID number (include a copy of your 147c letter from the IRS)
- If you are making changes to your practice location or tax ID, we require a signed copy of your 147C or CP575 letter. Please fax these documents to 1 (888) 289-1313.
- If changing your tax ID, you must re-register with Availity Essentials and re-enroll in electronic funds transfer. We also recommend you send your new tax ID to us 30 days in advance. We can then issue a new agreement before the start date of your new tax ID to avoid a lapse in your participating provider status. If we are not notified in advance, you may be considered an out-of-network provider for the dates between when your original agreement is terminated and your new agreement associated with your new tax ID is issued.
- Please allow 7 to 10 business days for the changes to be processed and updates to our system made.
After 10 business days, our Find a Doctor tool should reflect your changes.
If your clinic or facility emails monthly provider rosters to us, please submit changes, corrections, additions or terminations immediately so that we can update the information that is displayed in our online directories as soon as possible. Your roster must be reviewed and validated in its entirety at least every 90 days and you must respond promptly to any requests for roster review.
If you have changes to billing information, you will need to fax a copy of your CP 575 tor 147C to 1 (888) 335-3002. One of our representatives may contact you to verify information.
The following changes must be submitted in writing via certified mail:
- Terminating a network affiliation
- Closing a practice
We routinely audit the information in our provider database. Please be sure to respond to any requests from us for validation of your provider directory information. Even if the information we have is accurate, we need your response for confirmation.
Regulatory agencies, Centers for Medicare & Medicaid Services (CMS) and other entities may also audit our provider directory accuracy by contacting your office. Please designate a staff member to respond to these requests. It is critical that the responder is informed and aware of what networks you participate in, and can confirm whether you are accepting new patients or not.
CMS can fine insurers up to $100 per member for errors in plans sold on federally run insurance exchanges.