Verifying and updating your provider information

Maintaining accurate provider information is critically important to ensure our members have timely and accurate access to care.

 

Additionally, we are required by Centers for Medicare & Medicaid Services (CMS) to include accurate information in provider directories for certain key provider data elements.  For Anthem to remain compliant with federal and state requirements, providers must communicate changes to us 30 days in advance of a change or as soon as possible.

 

Key data elements

The data elements required by CMS and crucial for member access to care are: 

• Physician name
• Location (such as address, suite if appropriate, city/state, zip code)
• Phone number
• Accepting new patient status
• Hospital affiliations
• Medical group affiliations

 

We are also encouraged (and in some cases required by regulatory/accrediting entities) to include accurate information for the following provider data elements:

• Physician gender
• Languages spoken
• Office hours
• Provider specialty/specialties
• Physical disabilities accommodations
• Indian Health Service status
• Licensing information (i.e., medical license number, license state, National Provider Identifier - NPI)
• Email and website address

How to verify and update your information

To verify information, go to anthem.com, select ‘Providers’, then under ‘Provider Resources’ select ‘Find a Doctor’ tool.  Use ‘Search as a Guest’ at the bottom.  If your information is not correct, please update the information as soon as possible. 

 

To update information, go to anthem.com, select “Providers’, and then under ‘Provider Resources’ select ‘Provider Maintenance’ and follow the online prompts.