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. With the passage of the No Surprises Act, payers must have processes in place to suppress unverified providers from their directories.

The Centers for Medicare and Medicaid Services (CMS) and the department of Health and Human Services (HHS) now require all payers, including commercial health plans, to check with their providers quarterly to make sure their directory information is correct. Every 90 days, each of your payers will ask you to verify your information they have on file,. That means a lot of repetitive work for you.

Until now.

Availity’s Directory Verification app in Availity Essentials 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 it 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.

What can I update in Availity PDM?

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

What else can I do on Availity Essentials?

Availity Essentials 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 Essentials, 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 Availity Essentials.

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

Frequently Asked Questions

Q: Why do I have to do this every 90 days if nothing has changed?

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 inform them of a change.

Q: Why are provider directories getting so much attention?

Patients use provider directories—published by your payers—to find information about your organization. An important part of reducing or eliminating surprise billing for patients is ensuring those directories accurately reflect specialties and network participation by providers. With the passage of the No Surprises Act, if you don’t regularly verify your organization’s information, a payer may choose to exclude it from their directories.

All payers are now required to check with their providers quarterly to make sure their directory information is correct. Every 90 days, each of your payers will ask you to verify your information they have on file.

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

Q: Why is "Service Location" so important?

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 insurance company and specific network to sign up for based on physician locations and office hours.

Q: Which phone number should I provide?

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 Provider Data Management app in Availity Essentials 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.

Q: Can I share the updates I submit through Availity with other payers?

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

Q: How do I get help if I'm stuck?

If you have technical problems, or need to know more about provider directory updates, please call Availity Client Services at 1-800-242-4548 from 8:00am to 8:00pm Eastern time.

Q: What is QuickVerify and how am I eligible?

QuickVerify is a way for a provider to confirm that nothing has changed without requiring them to move the entire verification process. Anyone that has attested within the past two quarters is eligible for QuickVerify.