Verify and Update Your Information

Commercial facility and ancillary providers, including labs and dental providers, should continue to verify their directory information every 90 days using the Demographic Change Form.

See our guide on using the Demographic Change Form to verify data.

State requirement: Illinois House Bill 5395 (Public Act 103-0650) mandates auditing of all commercial and Qualified Health Plan network directories every 90 days. The audited information includes:

• Provider name
• Provider specialty
• Gender
• Languages spoken and language line availability
• Phone number
• Website address    
• Practice locations
• Telehealth capabilities
• Board certifications
• Medical group affiliations
• Facility affiliations
• Appointment availability (accepting new patients)

To fulfill the auditing requirement, we require that commercial provider groups submit a fully completed roster every 90 days (at least once every quarter). Solo commercial professional providers are encouraged to use a roster to meet this requirement.

If we haven’t received a roster within the last 90 days, we’ll call you to request your roster submission and to verify your information. 

• If we don’t receive a roster within 10 business days of phone outreach, your provider information may be removed from our network directories for 60 days.
• If we receive a roster within 60 days of directory removal, we’ll review your submission to determine whether provider information will be restored in our network directories.
• If we don’t receive a roster within 60 days of directory removal, affected providers may be subject to termination from the applicable networks.

Federal requirement: The federal Consolidated Appropriations Act of 2021 requires that the following directory information be verified every 90 days: 

• Name
• Address
• Phone
• Specialty
• Digital contact information (website).

This data must be verified every 90 days even if it hasn’t changed since you last verified it. Under CAA, we’re required to remove providers whose data we’re unable to verify from displaying in our directory. 

If you have a National Provider Identifier: When your information changes:

1.    Update the Centers for Medicare & Medicaid Services’ National Provider Identifier Registry

2.    Update us

Refer to the National Plan & Provider Enumeration System FAQs and CMS for more information.

Changes to your information must be submitted electronically unless you have otherwise opted out of conducting business with us electronically; in that case, changes will be accepted by U.S. mail.

Groups and solo professional providers may update information by roster.

Submitting a complete, updated roster also satisfies 90-day verification requirements for commercial providers.

There are two options to update by roster:

• Email the Provider Roster Requests team to obtain your current roster. Update as needed. Submit your completed roster to the Provider Roster Requests team, or 
• Submit a complete, updated version of the Universal Illinois Association of Medicaid Health Plans Roster to our Provider Roster Requests team

Medicare Advantage providers: Follow the process above to request and submit your updated roster, if your information isn’t included on your group roster.

Medicaid providers: If your medical group would like to use the Universal Illinois Association of Medicaid Health Plans Roster to submit provider updates, send a request to Government NetOps Provider Update.

Groups, solo professional providers and facility and ancillary providers may use the Demographic Change Form to update data when it changes.

Labs and dental providers must use the Demographic Change Form to update information.

Continue to verify: Updating information on this form doesn’t satisfy 90-day verification requirements for commercial providers. If you’ve made an update using the form, continue to verify your information every quarter.

Changes you can make using the form:

• Provider’s personal information
• Legal name for rendering provider
• Provider hospital privileges
• Service location address and contact information, including phone, fax, email (indicate in the form comments section if you are adding or changing a location)
• Website URL
• Hours of operation
• Language spoken
• Billing contact information
• Credentialing contact information
• Administrative contact information
• Provider roster information (removing a provider from the group or location)

If you completed a Demographic Change Form: You can check the status of your update by entering the case number you received in your confirmation email in our Case Status Checker. You may also verify your update by reviewing Provider Finder.

Professional and most facility and ancillary providers may update some information in the Provider Data Management feature in Availity Essentials.

Labs and dental providers must use the Demographic Change Form rather than PDM to update information.

Continue to verify: Updating information in PDM doesn’t satisfy 90-day verification requirements for commercial providers. If you’ve made an update using PDM, continue to follow the process outlined above to verify your information every quarter.

Changes you can make in PDM:

• Provider's personal information
• Service location address change and contact information
• Payment address change and contact information
• Hours of operation
• Languages spoken
• Business website URL

Group legal name change for existing contract: Complete a new contract application to initiate the update process.

If you need to add a provider to your current contracted group: Complete a credentialing application through CAQH and the Provider Onboarding Form to initiate the process.