Provider Data Accuracy Compliance

Educational presentation   


The Centers for Medicare and Medicaid Services (CMS) requires of Highmark and its network providers that current, accurate provider data is published in Highmark's Provider Directory.  The Provider Directory is an important tool that helps our members contact practitioners, and the data itself is what drives timely and accurate claims processing. Additionally, please note that if you do not maintain accurate provider data, your status within Highmark’s networks may be impacted, resulting in the inability to service patients who have Highmark insurance.

Highmark is committed to ensuring the information in the Provider Directory meets our standards for quality and the standards set forth by CMS. CMS requires ongoing review of all physician information listed in the directory to confirm:

  • The provider name is correct.
  • The practice name is correct.
  • The provider’s specialties are correctly listed.
  • There are not providers listed at practice locations where they don’t actually practice.
  • The provider is accepting new patients, or not accepting new patients, at the location.
  • The provider’s street address and phone number are correct.

There are two ways you can update your directory information with Highmark, the first is through NaviNet under Provider File Management.

To access Provider File Management:

  1. Log into NaviNet
  2. Navigate to Workflows/My Health Plans and choose the appropriate Highmark plan(s)
  3. Select Provider File Management from the Workflows for this Plan menu
  4. Click the square next to the practice address
  5. Select Edit
  6. Update the necessary fields and click Submit

You can also update your directory information by completing the appropriate forms on the Provider Resource Center and returning them to the fax number on the bottom of the form.

To access the forms:

  1. Click Forms in the left-hand menu
  2. Select Provider Information Management Forms
  3. Fill out the appropriate form and send it back to the fax number listed on the bottom of the form

*For Facility and Ancillary Providers, please use the Address/Phone Number Change Form for Facility & Ancillary Providers Form to submit any changes.

Last updated on 8/14/2018

 

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