Updating Your Provider Information
Having current provider information helps us maintain accurate provider directories, ensuring you are easily accessible to our members.
Health plans are required by Centers for Medicare & Medicaid Services (CMS) and other regulatory entities to have accurate information in provider directories, which are routinely reviewed and audited. As noted in Section 2.6 of your agreement, “Participating Providers shall promptly notify Health Plan in writing of any change in his or her practice.”
Key Data Elements
Data elements required by CMS and crucial for member access are:
- Provider/physician name and National Provider Identifier (NPI)
- Practice location(s) and Group Name (phones number, fax numbers, address, suite, city, state, ZIP code).
- Office hours
- Patient acceptance
- Practicing specialty
- Awareness of provider’s participation in our network
Health plans also should include up-to-date information for the following:
- Anticipated changes in participation with health plan (e.g. retirement, moving out of area, available as covering only)
- Languages spoken
- Physical disabilities accommodations
- Indian health service status
- Licensing information
- Provider credentials
- Board certification
- Email addresses
- Any change that may materially impair your ability to carry out the duties and obligations of our agreement
- Hospital affiliation
Current practice information can be reviewed on our online provider finder at bcbswny.com/provider.
Updates can be submitted by completing a Provider Demographic Change Form
View Forms and select Provider Demographic Change Form under the Practice Administration heading. You can also email us email@example.com. Please include your individual NPI number in the subject line.
Changes also should be reflected on your Council for Affordable Quality Healthcare (CAQH) application.
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