Protect Your Network Status: Ensure Your Directory Information Stays Current

When Highmark members are looking for a 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 will be immediately removed from the directory and their status within Highmark’s networks may be impacted.

The Centers for Medicare & Medicaid Services requires Highmark to conduct a quarterly outreach to validate provider information. We use this information to populate our Provider Directory and to help ensure correct claims processing. Each review confirms:

• The practitioner name is correct. For example, we must ensure the practitioner’s name in the directory matches the name on his/her medical license.

• The practice name is correct. For example, is there a difference between the practice name that is being used when phones are answered versus the practice name listed in the directory?

• The practitioner’s practicing specialties are correctly listed. Is there more than one specialty listed in the directory? Are both specialties being practiced?

• Practitioners are not listed at practice locations where they don’t actually schedule appointments and see patients. Practitioners listed must be affiliated with the group. Practitioners who cover on an occasional basis are not required to be listed. Practitioners who do not see patients on a regular basis at a location should not be listed at that location.

• 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.

Note: Your up-to-date information must include your current address, phone number, fax number, and any and all required data elements set forth in the provider contract(s) with Highmark.

It’s vital that all providers review and update their information in NaviNet®. Information should be updated as soon as a change occurs. All data should be reviewed at a minimum of once a quarter to ensure it’s accurate. Detailed instructions are available in the Provider File Management NaviNet Guide, which is available on the Provider Resource Center under Education/Manuals.

Highmark and its designated agent, Atlas, are currently making outreach calls to providers to verify the accuracy of provider data. If you receive a call, please provide our agent with the requested information.

Note About Lactation Services

Does your practice offer lactation counseling services? If so, you need to update your provider directory information in NaviNet to let our members and your potential new patients know about the services you deliver. To confirm or update your information:

• Select Provider File Management.
• Select Practice Location to edit.
• Expand Office Accessibility and Services.
• Click Edit on Services Offered at this Location.
• Select the box that reads Lactation Counseling, and then click Submit.