The Centers for Medicare & Medicaid Services and other regulatory bodies require health plans to maintain and update data in provider directories, and we rely on our providers to review their data and notify us of any changes as they happen to ensure that members have access to accurate information.
CAQH DirectAssure implementation
Harvard Pilgrim is participating in efforts through HealthCare Administrative Solutions to institute a centralized process for providers (using CAQH’s DirectAssure®) to review and report changes to demographic data. Implementation for directly contracted providers was successfully implemented in Massachusetts, New Hampshire, and Maine, and Connecticut. A phased roll-out will continue through the remainder of the calendar year to our remaining contracted and marketed provider network. To learn more, visit the HCAS website.
Review your data and report changes
If you are not currently using DirectAssure for provider directory updates, please continue to use existing processes to review and report changes to your address, panel status (open or closed) for each individual provider, institutional affiliations, phone number, and other practice data. We encourage you to review the online Provider Directory regularly to verify its accuracy. If you need to update any information, please fill out a Provider Change Form and submit it to Harvard Pilgrim’s Provider Processing Center by email at PPC@harvardpilgrim.org. Failure to review and update demographic information at least quarterly may result in directory suppression until such information is validated.
If Harvard Pilgrim identifies potentially inaccurate provider information in the directory, we may outreach to your practice to validate or obtain accurate information. In the event that we are unable to obtain a timely response to our request, the provider’s applicable location may be subject to suppression in the directory until up-to-date information is received.
Practice location information
As new providers join your practice, it is important that only practice locations where the provider regularly administers direct patient care are submitted for inclusion in the Harvard Pilgrim provider directory. Locations in which a provider may occasionally render indirect care — such as interpretation of tests or inpatient-only care — should be specified to ensure the location information is included in the provider’s demographic profile, but not in the provider directory.
As a reminder, notification of address, acceptance of new patients, provider terminations, and other demographic information changes should be submitted at least 30 days in advance. Provider demographic information in our directory must reflect accurate data at all times and should mirror the information members may receive directly from the practice or via patient appointment call centers. For questions, call the commercial Provider Service Center at 800-708-4414 or the Medicare Advantage Provider Service Center at 888-609-0692.