When seeking health care services, our members often rely upon the information in our online Provider Finder®. The federal Consolidated Appropriations Act of 2021 requires that certain provider directory information be verified every 90 days.
Under CAA, we’re required to remove providers from our Provider Finder whose data we’re unable to verify.
What to Verify
Verify your name, address, phone, specialty and digital contact information (website) every 90 days. It must be verified every 90 days even if your data hasn’t changed since you last verified it.
You also 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 Provider Finder, it may limit member cost-sharing to in-network levels. Learn more about the CAA.
How to Verify Information
Professional providers – We recommend using the Provider Data Management feature to quickly verify and update information with us and other insurers every 90 days. See our PDM page and user guide for more details.
If you’re unable to use Availity, use our . See our user guide on how to verify your data using the form.
Professional provider groups – Groups can verify individual providers using the
Professional provider groups who submit changes by roster can verify all their providers’ information every 90 days with their roster. 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.
Acute and ancillary facilities – Facilities and ancillary providers may use only the to verify and update data. See our user guide for more details.
How to Make Updates
If you need to change your data, follow the instructions below. Updating your data will count as your 90-day verification. We won’t accept demographic changes by email, phone or fax to enable us to meet the two-day directory update requirement defined by the CAA. Any demographic updates requested through these channels will be rejected and closed. Changes 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.
Professional providers may update some data using the PDM feature, including:
- Personal information
- Service location address change
- Payment address change and contact information
- Hours of operation
- Business website URL
- Legal name for provider
- NPI/Tax ID
- Directory information:
- Office physical address
- Hours of operation
- Billing contact information
- Credentialing contact information
- Administrative contact information
- Provider roster information (removing a provider from the group or location)
Please indicate in the form comments section if you are adding or changing a location.
If you completed a Demographic Change Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker .
If you need to add a provider to your current contracted group, complete the Provider Onboarding Form . Once the form and credentialing requirements are complete, we will appoint the provider into the network and send a letter to the contracted group. Credentialing can take 30 to 120 days.
Note: The CAQH Credentialing Application must be complete prior to completing the Provider Onboarding Form. Credentialing is required for Professional Provider Types: MD, DO, PSYD, DC, CNM, LCSW, LCPC, LMFT, DPM, PA, APN, CNP, RD, LAC and DN.
Additional Information Changes
Legal Name Change for Existing Contract
If you are an existing provider who needs to report a legal name change, complete a new contract application to initiate the update process.
Medical Group Change for Multiple Providers
If you are a group (Billing NPI Type 2) and have more than five changes, please send a request to IL Provider Roster Request to obtain a current copy of your roster to initiate your multiple change request.
For Medicaid, if your medical group would like to use the Government Medicaid Roster to submit provider updates, send a request to Government NetOps Provider Update.
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.