Make sure your practice information is up to date with contract payers
November 09, 2021
Every practice understands the importance of collecting up-to-date patient demographic information, including changes to a patient’s address, phone number, insurance, eligibility and benefits. Keeping these items up to date ensures that the practice can quickly communicate test results or other medical issues with the patient, as well as schedule and confirm appointments. Accurate information about patient insurance, eligibility, and benefits also helps avoid unnecessary refusals or late payments, and goes a long way in saving the practice time and money.
Equally important is that doctors make sure their practice demographic information is up to date with all contract payers.
Reason # 1 – Up-to-date information about the practice such as specialty, address, tax identification number (TIN), name of the practice and the full list of doctors in the practice (along with their national supplier identification numbers ) ensure that payments and other essential contractual advice are received by the practice.
Reason # 2 – Providing up-to-date and accurate practice information to payers ensures that your information is displayed correctly for patients looking for a physician in payers provider directories. This also helps reduce the risk of late or refused payment.
Reason # 3 – This will likely keep your practice in line with your contracts. Most payers have clauses in their contracts that require physicians to notify the payor in writing of any change in their practice.
To ensure that your information is accurate, firms are encouraged to review their information with each payor under contract at least once a year. However, if a practice moves, adds or loses providers, changes the practice name and / or TIN, closes a practice or changes specialty, it is important to notify the payer in advance.
Information that should be considered includes, but is not limited to:
- Practice name
- Practice the NIF
- Practitioner and doctor NPI
- Practice physical address
- Convenient phone number
- Payment address
- Email address of physician or primary administrator (if available)
- Convenient fax number
- If the practice is open / closed to new patients
- Languages spoken (if published)
- Products for which the practice is contracted
- Service providers included in the contract
- Providers leaving / joining the practice
- Hospital privileges
The California Medical Association (CMA) surveyed top payers about their processes for updating provider demographics and compiled their responses into a new resource for physicians, “Update vendor demographic information with payersWhich is free to CMA members.
Firms should be aware that updates to vendor demographics can take up to 90 days. It is therefore extremely important to submit an update to the payer as soon as the information changes.