The Consolidated Appropriations Act of 2021 (CAA) requires providers to inform health plans when there are any material changes to their provider directory information, as well as when they begin or terminate a network agreement. The CAA also requires health plans to verify each provider’s demographic information listed in the provider directory at least every 90 days. Providers are required to respond when a health plan, such as ours, requests information.
EmblemHealth and ConnectiCare are exploring ways to leverage our secure provider portals to simplify for you this verification process, as well as the submission of directory updates.
Currently, you may use the Provider Profile on the Provider Portal to add a new location or to remove a location. To request corrections to an existing location, you can send us a note through the Message Center; a link is available from the Provider Profile.
Organizations with delegated credentialing agreements (EmblemHealth/ConnectiCare) should continue to manage their information’s accuracy through their regular monthly data file submission processes.
Other Data Accuracy Efforts
Medicare Advantage
For Medicare Advantage plans*, the Centers for Medicare & Medicaid Services (CMS) is looking to health care providers to review, update, and certify their National Provider Identifier (NPI) and related information in the National Plan & Provider Enumeration System (NPPES). When reviewing NPPES:
- Remove practice locations that are no longer in use.
- Correct inaccurate information in modifiable fields.
- Include all addresses where you practice, actively see patients, and where a patient can call and make an appointment.
- Exclude addresses where you could see a patient, but do not actively practice.
New York State Medicaid
In addition, New York State providers in our Enhanced Care Prime Network must notify Medicaid of any change of address, telephone number, or other pertinent information within 15 days of the change. For more information on this requirement and how to submit changes, see Reminder: Keep Your Directory Data Current.
*Includes: Medicare Advantage Organizations, Medicare Advantage - Prescription Drug Organizations, Section 1876 Cost Plans, Prescription Drug Plan Sponsors, Employer/Union-Sponsored Group Health Plans, and Medicare-Medicaid Plans. NPPES has no bearing on billing Medicare Fee-For-Service.
