Verify and Update Your Information

When seeking health care services, our members and other professionals trying to make referrals, often rely upon current and accurate 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 displaying in 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 .

Professional Providers

We recommend you use the Provider Data Management feature on Availity^® Essentials  to quickly verify and update information. If you’re unable to use Availity, you may submit a Demographic Change Form . Refer to the User Guides section below for how to use this form for verification purposes.

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 you can make in Provider Data Management via Availity 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 you can make using the Demographic Change Form  include:

• Legal Name
• NPI/Tax ID
  In-network Providers or Groups – Prior to changing a TAX ID or requesting termination from a provider network, (excluding Par Plan Agreement) contact your Network Management Office Location before completing this form.
• Email (we can house up to 10 email addresses
• Office Service Locations (Address, phone, fax, email and hours of operation are required)
  • Primary Physical Address
  • Directory Location/Satellite Address
• Other Information
  • Billing Address for group – include W9 and Letterhead from Group
    • Address, phone, fax and email information are required.
  • Credentialing contact email/fax/phone
  • Administrative contact email/fax/phone
• Electronic commerce information options

See User Guide section below for assistance

Note: If a change impacts multiple providers or groups, submit the Demographic Change Form for each provider and/or group provider record number or provider location impacted.

Hospital, Facility and Ancillary Providers

Facilities should use the Demographic Change Form  rather than Availity to verify and update information.

• Email (we can house up to 10 email addresses)
• Service Location Address Email/Fax/Telephone and Hours of Operation. (Submit copy of license with matching address for this location)
• Other Information
  • Billing Address (Phone, fax, and email are required)
  • Credentialing contact email/fax/phone
  • Administrative contact email/fax/phone

Note:

• Refer to electronic commerce information options for updates.
• For changes of ownership (CHOW), use the Consent to Assignment of Provider Contracts form.
• All other Hospital, Facility and Ancillary changes, please contact your Network Management Office Location

User Guides for the Demographic Change Form

• Refer to the How to use our Demographic Change Form to Verify Directory Information User Guide when verifying information related to CAA.
• Utilize the Demographic Change Form User Guide for assistance on updating your information.

Setting Up a Provider Record ID

Providers should refer to the Provider Onboarding Process to request a BCBSTX Provider Record ID and contracts if needed.

Case Status Checker

If you have completed a Demographic Change Form or a Provider Onboarding Form, you can check the status by entering the case number you received in your confirmation email in our Case Status Checker .

For the status of your professional contract application, or if you have questions or need to make changes to an existing contract, please contact your Network Management Consultant.