Update and Verify Your Information

When seeking health care services, our members rely on the information in our online directory. 

You must update your directory information when it changes, including if you join or leave a network. If you’re contracted with our commercial networks, your directory information must be verified every 90 days (at least once every quarter), even if it hasn’t changed since you last verified it.

More details are below on tools to verify and update your information, as well as state and federal requirements. If you have questions, contact your Provider Relations Representative.

Update Your Information When It Changes

You must update your information when it changes, including if you join or leave a network. If you leave a network, continue to update your information immediately and according to your contract terms. If you’re incorrectly identified as an in-network provider in our provider directory, it may limit member cost-sharing to in-network levels.

More details are below on options to update your information. 

  • Update by Availity® Essentials: Professional, Facility and Ancillary

    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 for Illinois House Bill 5395 (Public Act 103-0650), also known as the Health Care Protection Act. If you’ve made an update using PDM, continue to follow the process outlined below 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

  • Update by Roster: Groups

    Groups 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:

    Or 

    • Submit a complete, updated version of the Universal Illinois Association of Medicaid Health Plans Roster through our online roster submission form. Download the roster template from the IAMHP website.

    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. Download the roster template from the IAMHP website.

  • Update by Demographic Change Form: All Providers

    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 for Illinois House Bill 5395 (Public Act 103-0650). 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
    • Specialties
    • 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
    • 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 our online directory.

  • Other Group Updates

    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 the Provider Onboarding Form to initiate the process and ensure the provider has a current credentialing application through CAQH.

Verify Your Information Every 90 Days

Directory information for commercial providers must be verified every 90 days. This fulfills requirements of Illinois House Bill 5395 (Public Act 103-0650), also known as the Health Care Protection Act, and the federal Consolidated Appropriations Act of 2021.

Quarterly verification is also required to help ensure continued participation in our commercial networks.

  • Verify by Roster: Commercial Groups and Solo Professional Providers

    • Commercial provider groups are required to submit a complete roster to us every 90 days to verify your information. When a group submits a roster, all providers affiliated with this group and not listed with an update are verified as correct with no changes.

    • Commercial solo professional providers are encouraged to submit a roster to us every 90 days to meet the verification requirement. This is the most efficient way to verify all directory information and will help reduce calls to your office for verification purposes.

    There are two roster options to fulfill the requirement:

    1.  Request your current roster from us every quarter using our new online roster request form. Please request only one roster every 90 days; multiple requests may delay our response.

    • Include your tax ID number  on the form.

    • After submitting your request form, you’ll receive an email with a case number to use in our case status checker. Allow approximately four weeks to receive your roster. 

    • Review your roster for accuracy and make updates if needed to provider names, locations, phone numbers, websites or other data. Don’t hide, change or add columns or alter the roster format.

    • Submit your completed roster to us through our online roster submission form.

    • If you have questions about rosters, submit them through our online roster inquiry form. 

    Or, 

    2. Use the updated version of the Universal Illinois Association of Medicaid Health Plans Roster. Complete and submit the IAMHP roster through our online roster submission form at least once every quarter. You can download the roster template from the IAMHP website.

    • HMO Medical Groups or Independent Physician Associations: Continue with your normal process of submitting your complete, updated roster every month rather than every 90 days.
    • Medicaid and Medicare Advantage-contracted providers: Quarterly verification isn’t required for Medicare Advantage plans and Blue Cross Community Health Plans℠. However, it’s providers’ responsibility to submit demographic changes when they occur, in accordance with their contracts.

  • Verify by Availity Essentials: Facility, Ancillary and Professional

    Most facility and ancillary providers may use the Provider Data Management feature in Availity Essentials to quickly verify name, address, phone, specialty and digital contact information with us and other insurers every 90 days.

    Professional providers may use the PDM feature in Availity to verify information to meet federal CAA requirements. However, verifying in PDM won’t meet Illinois House Bill 5395 (Public Act 103-0650) requirements for commercial providers.

  • Verify by Demographic Change Form: Facility and Ancillary

    Facility and ancillary providers may verify their directory information every 90 days using the Demographic Change Form.

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

  • State Requirements

    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). 

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

    • If we don’t receive a roster within 10 business days of 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.

    If you have a National Provider Identifier: When your information changes, you must update both:

    1.    The Centers for Medicare & Medicaid Services’ National Provider Identifier Registry 
    2.    Blue Cross and Blue Shield of Illinois

    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.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.