November 09, 2021
Every practice understands the importance of collecting up-to-date demographic information from patients, including changes to a patient’s address, phone number, insurance, and eligibility and benefits. Ensuring that these items are up to date guarantees that the practice can quickly communicate with the patient about test results or other medical issues, as well as schedule and confirm appointments. Accurate patient insurance, eligibility and benefits information also helps to prevent unnecessary denials or delays in payment, and goes a long way toward ultimately saving time and money for the practice.
It is equally important that physicians ensure their practice demographic information is up to date with any contracted payors.
Reason #1 – Up-to-date practice information such as specialty, address, tax identification number (TIN), practice name, and complete list of physicians in the practice (along with their national provider identification numbers) ensures that payments and other vital contractual notices are received by the practice.
Reason #2 – Providing updated, accurate practice information to payors ensures that your information is displayed correctly to patients looking for a physician through payors’ provider directories. It also helps reduce the potential for delayed or denied payments.
Reason #3 – It will likely keep your practice compliant with your contracts. Most payors have language in their contracts that requires physicians to notify the payor in writing of any changes in their practice.
To ensure that your information is accurate, practices are encouraged to review their information with each contracted payor on an annual basis, at minimum. However, if a practice is moving, adding or losing providers, changing the practice name and/or TIN, closing a practice or changing specialties, it’s important to inform the payor ahead of time.
Information that should be reviewed includes, but is not limited to:
- Practice name
- Practice TIN
- Practice and physician NPIs
- Practice physical address
- Practice phone number
- Pay-to address
- Physician or lead administrator email address (if available)
- Practice fax number
- Whether the practice is open/closed to new patients
- Languages spoken (if published)
- Products for which the practice is contracted
- Providers included in the contract
- Providers leaving/joining practice
- Hospital privileges
The California Medical Association (CMA) has queried the major payors on their processes for updating provider demographic information and compiled their responses into a new resource for physicians, “Updating Provider Demographic Information with Payors,” which is available free to CMA members.
Practices should be aware that updates to provider demographics may take up to 90 days to complete – so submitting an update to the payor as soon as information changes is extremely important.