Availity Provider Data Management For Health Plans
Directory Information Verification for Providers

Keep your directory information up to date with all your payers

Patients use provider directories—published by your payers—to find information about your organization. For Medicare, Medicaid, and exchange patients, it’s especially important that these directories be accurate and up to date. If you don’t regularly verify your organization’s information, a payer may choose to exclude it from their directories.

The Centers for Medicare and Medicaid Services (CMS) now requires payers to check with their providers quarterly to make sure their directory information is correct. Each of your payers will ask you to verify your information they have on file, every 90 days. That means a lot of repetitive work for you.

Until now.

Availity’s Directory Verification app in the Availity Provider Portal lets you update your directory information online, using forms pre-populated with most of your information. You simply verify the information that’s correct, fix what’s wrong, and click the Submit button. Availity automatically sends your updates to payers who are working with us on their directories.

Instead of filling out multiple forms and faxing or emailing them to each health plan, you can make electronic updates right from your daily workflow and then send the edits to every health plan you contract with.

You can also download a report with all your verified information to send to other payers you work with when they ask for your updates.

Keeping your business and physician information current also helps you minimize costly and repetitive work caused by misdirected patient claims, payments, or general calls searching for specific roles within your business. This saves you money and time, and frees up staff resources to focus on patient care.

The healthcare industry is changing quickly, and providers and health plans need better ways to work together. Availity Provider Data Management is one way we can help ensure providers and health plans get the right information at the right time in the care cycle.

Register now to get started.

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The new Provider Data Management tool lets you maintain the following information:

  • Service locations and hours of operation
  • Providers who join your organization
  • Contact information for physicians and key staff
  • Whether you’re accepting new patients
  • Specialties
  • Languages spoken by physicians and staff
  • Other information that helps payers work with you

These payers are working with Availity to keep their provider information up to date and accurate, and more are being added every month:

  • Humana
  • Florida Blue
  • Aetna
  • AvMed
  • Cigna
  • WellCare

After you complete the verification process, you’ll be able to download a report in PDF format that includes any updates you’ve made and affirms that the information is accurate. You can send that to other payers you work with, or use it as a resource to complete their proprietary workflows and forms.

The Availity Provider Portal gives you one place to exchange administrative, clinical, and financial information with most of the nation’s leading health plans. When you log in to the portal, you’ll be able to:

  • Check eligibility and benefits
  • Submit professional and facility claims
  • Check on your claim and remittance status
  • Request authorizations and receive referrals
  • Get fee schedules and other payer-specific information
  • … and more

The Availity Learning Center offers a wide variety of on-demand and live webinars that cover topics that matter to healthcare administrators, including courses on coding, hiring and training staff, changes in healthcare regulations, and more. There are also videos and other resources to help your staff get up to speed on all the things you can do on the Availity portal.

Many payers also have “Payer Spaces,” which are secure linkouts to payer-specific information and apps, so the Availity Portal cuts down on the number of passwords and logins you need to remember.

Patients use your payers’ provider directories to find information about your organization. For Medicare, Medicaid, and exchange patients, it’s especially important that these directories be accurate and up to date. If you don’t regularly verify your organization’s information, a payer may choose to exclude it from their directories.

The Centers for Medicare and Medicaid Services (CMS) now requires payers to check with their providers quarterly to make sure their directory information is correct. Each of your payers will ask you to verify the information they have on file for you, every 90 days.

 

Here’s a look at the ways inaccurate provider information adds costs to every step of health care.

The CMS says inaccurate provider directories are a “significant barrier to care.” Patients need to know where they can schedule appointments and see doctors who are in network for their insurance plans. Many people even decide what insurance company and network to sign up for based on physician locations and office hours.


Patients need to know what number to call to make an appointment. That’s the number that should appear first in your payers’ directories.

Availity’s Provider Data Management app in the Provider Portal also allows you to enter billing, mailing, and business locations and phone numbers. That information makes it easier for your payers to contact the right person in your office when they need information to complete a claim, settle an overpayment, or conduct other business with you.

State and federal regulations require your payers to contact you every 90 days to verify that the information they are providing their members via provider directories. The regulations also give the payer a limited amount of time to update their directories when you do inform them of a change.

You can. After you’ve verified all the directory information is correct, you can download an electronic copy of your verified information. You can email or print to mail or fax the information to all your payers who are requesting verification.

If you have technical problems, or need to know more about provider directory updates, please call Availity Client Services at 1-800-282-4548 from 8am to 7:30pm Eastern time.