Quarterly Provider Directory Validation

The sign in front of your office helps members find their way to you. Your contact information in the online Highmark provider directory does the same.

You are required to supply Highmark with your practice name, clinical team, locations, and contact information for our provider directory. It is essential that Highmark has your up-to-date information in order to help our members make informed decisions on where to seek care. You are required to supply Highmark with your information on a quarterly basis.

Reviewing Data is Vital For You

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

Per the No Surprises Act, providers who don’t confirm and attest that their data is accurate will be immediately removed from the provider directory, and their status within Highmark’s networks may be impacted.

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 are not required to 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.

Change Happens

It’s vital that you review and update your information as soon as a change occurs. Go to Provider File Management within NaviNet® to check these fields:

  • Current address
  • Phone number
  • Fax number

Remember to review data at least once a quarter to ensure it’s accurate.

Detailed instructions are available in the Provider File Management NaviNet Guide, which is 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 help our agent to gather the right information.

Atlas is an independent company that performs outreach to physicians on behalf of Highmark.