Ensure Your Directory Information Stays Current

Ensure Your Directory Information Stays CurrentWhen Highmark Blue Shield of Northeastern New York (BSNENY) members are looking for a primary care physician (PCP) or specialist, they expect that our online provider directory presents information that is accurate and current.

That’s why it is essential to ensure that your practice information on file with Highmark remains up to date.

Please be aware that providers who don't validate their data quarterly may be removed from the directory and their status within Highmark’s networks may be impacted.

Reviewing Data Is Vital for You

The Centers for Medicare and Medicaid Services (CMS) requires Highmark to reach out to you every quarter and ask you to validate your provider directory information. We use this information to populate our online provider directory and to help ensure correct claims processing.

Your thorough review of your directory information confirms:

  • Each practitioner’s name is correct and matches the name on his/her medical license.
  • The practice name is correct and matches the name used when you answer the phone.
  • All specialties are correctly listed and are currently being practiced.
  • Practitioners listed at a location currently see members and schedule appointments at that office on a regular basis.
    • All practitioners listed must be affiliated with the group. Practitioners who cover on an occasional basis should not be listed.
  • The practitioner is accepting new patients — or not accepting new patients — at the location.
  • The practitioner’s address, suite number (if any), and phone number are correct.

Attestation through BetterDoctor

Highmark BSNENY works with the vendor BetterDoctor to help keep our network provider information current. As part of our network, you can expect to receive emails from BetterDoctor every quarter. Your office may also receive a request from BetterDoctor to validate your information online.

New PDM Tool for Professional Providers

Starting June 1, 2023, Highmark will launch a new Provider Data Maintenance (PDM) tool available on the Provider Resource Center that will enable professional providers to review and validate their directory information. See the article about the PMD tool in this month’s issue of Provider News.

Professional providers can still attest to their information via BetterDoctor, if they choose to do so.

You can contact BetterDoctor’s Customer Service team by emailing support@betterdoctor.com or by calling 844-668-2543.

 

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