NaviNet Provider File Management:
We’ve Listened to Your Concerns and Made Improvements

As you know, Provider File Management is a data management tool within Highmark’s NaviNet^® system that providers use to update their directory information and make sure it’s current and correct. Until now, this function proved to be difficult to use, especially for providers who have multiple locations and staff.

In response to your concerns, Highmark has updated Provider File Management and made it easier than ever to ensure your directory information remains valid. With this valuable resource, you can easily update practitioners' information and their office addresses, request credentialing, update and maintain your patient acceptance panel, and add new accreditations.

While the Centers for Medicare & Medicaid Services (CMS) requires providers to update their directory information at least quarterly, we suggest you make updates as soon as changes occur, for the benefit of your patients. Highmark members who are looking for a PCP or specialist expect that the online provider directory presents information that is accurate and current. Without your help, this service may not provide the best access to care for these members.

Reminder: Protect Your Network Status

It’s essential that your practice information on file with Highmark remains up to date and is attested to on a quarterly basis.

Providers who don't validate and attest that their data is accurate will be immediately removed from the directory, and their status within Highmark’s networks may be impacted.

CMS requires Highmark to conduct a quarterly outreach to validate provider information. We use this information to populate our provider directory and to help ensure correct claims processing. Each review confirms:

• The practitioner name is correct. For example, we must ensure the practitioner’s name in the directory matches the name on his/her medical license.

• The practice name is correct. For example, is there a difference between the practice name that is being used when phones are answered versus the practice name listed in the directory?

• The practitioner’s practicing specialties are correctly listed. Is there more than one specialty listed in the directory? Are both specialties being practiced?

• Practitioners are not listed at practice locations where they don’t actually schedule appointments and see patients. Practitioners listed must be affiliated with the group. Practitioners who cover on an occasional basis are not required to be listed. Practitioners who do not see patients on a regular basis at a location should not be listed at that location.

• The practitioner is accepting new patients — or not accepting new patients — at the location.

• The practitioner’s address, suite number (if any), and phone number are correct.

Note: Your up-to-date information must include your current address, phone number, fax number, and any and all required data elements set forth in the provider contract(s) with Highmark.

It’s vital that all providers review and update their information in Provider File Management within NaviNet. Information should be updated as soon as a change occurs. All data should be reviewed at a minimum of once a quarter to ensure it’s accurate. Detailed instructions are available in the Provider File Management NaviNet Guide, which is available on the Provider Resource Center under Education/Manuals.

Highmark and its designated agent, Atlas, are currently making outreach calls to providers to verify the accuracy of provider data. If you receive a call, please provide our agent with the requested information.