When seeking health care services, our members often rely upon the information in our online Provider Finder®. Beginning Jan. 1, 2022, the federal Consolidated Appropriations Act (CAA) of 2021 requires that certain provider directory information be verified every 90 days.
This means that starting Jan. 1, 2022, you must:
- Verify your name, specialty, address, phone and digital contact information (website) for our provider directory every 90 days, and
- Update your data when it changes, including when you join or leave a network
Under CAA, we’re required to remove providers from our Provider Finder whose data we’re unable to verify.
If you leave a network, you should 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 and Update
We recommend professional providers use the Provider Data Management feature on Availity® to quickly verify and update information. If you’re unable to use Availity, you may submit a Demographic Change Form .
Facilities may only use the Demographic Change Form to verify and update data. See our user guide on how to verify information using the form.
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.
Changes professional providers can make in the Availity Provider Data Management feature include:
- Personal information
- Service location address change
- Doing Business As (DBA) name
- Payment address change and contact information
- Hours of operation
- Business website URL
Changes providers and facilities can make on the Demographic Change Form include:
- 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 a location 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.