CAA: Providers required to verify online provider directory information

Summary:

• The Consolidated Appropriations Act (CAA) requires care providers to validate their online directory details every 90 days to remain listed.
• Anthem's provider data management (PDM) on Availity Essentials enables care providers to verify and update their information efficiently.
• Care providers can submit data updates through the PDM's Roster Automation solution using a standard Microsoft Excel document.

The CAA of 2021 requires care providers to review and verify the accuracy of the following information in the online provider directory every 90 days:

• Provider/facility name
• Address
• Specialty
• Phone number
• Digital contact information

Providers who fail to verify their information every 90 days may be removed from the online provider directory.

Providers will be reinstated to the online provider directory once verification is complete.

Anthem uses a proactive monitoring and correction program to further ensure provider directory data is accurate. The program uses technology and various data sources to confirm the status and accuracy of the directory data. Providers may be removed from the directory when it is determined the provider data is inaccurate.

Review, verify, and update your directory information

To review, verify, and update your online directory information, Anthem uses the provider data management (PDM) capabilities of Availity Essentials to update provider or facility data. Using the Availity PDM application meets the verification requirement to validate provider demographic data set by the CAA.

PDM features include:

• Updating provider demographic information for all assigned payers in one location.
• Verifying and managing current provider demographic information.
• Monitoring submitted demographic updates in real-time with a digital dashboard.
• Reviewing the history of previously verified data.

To access the PDM application, log on to https://Availity.com and go to My Providers > Provider Data Management. Administrators are automatically granted access to PDM. Additional staff may be given access to PDM by an administrator. To find your administrator, go to My Account Dashboard > My Account > Organization(s) > Administrator Information. View the Availity PDM quick start guide here (PDF).

Use Roster Automation to submit provider demographic changes

Within the PDM application, providers also have the choice and flexibility to request data updates using our Roster Automation solution by submitting a spreadsheet via a roster upload.

Provider data additions, changes, and terminations, including requests to suppress a provider from provider directories, are submitted on a standardized Microsoft Excel document. Provider suppression should occur for office locations at which the provider does not routinely accept patient appointments (for example, the provider only covers/floats at that location).

The resources for this process are available on our website. Visit Anthem.com > For Providers > Forms and Guides. The following two resources appear under the Digital Tools category:

• Roster Automation Rules of Engagement: This is a reference document available to ensure error-free submissions for accurate and timely updates through automation.
• Roster Automation Standard Template: Use this template to submit your information. More detailed instructions on formatting and submission requirements can be found on the first tab of the template, User Reference Guide.