Reviewing Payer Websites Shows Outdated Information

April 2, 2016
P.J. Cloud-Moulds

Medical practices must make it a point to periodically review payer websites and make sure that their information is correct.

I recently logged on to several payer websites and found multiple errors and outdated information about my practice. They listed an office that has not existed since 2012, and several physicians who joined the practice were incorrectly identified as non-board certified. If patients use insurance plan websites to find a physician in their network and your practice is not listed or has outdated information, it is missing out on an important source of new patients.

The best way to go about updating your information is to start with the payer website and go to the "Provider" section. Payers will often have fee schedules, contract information, forms, and contact information there. Look for a "Physician Change Request Form" or something similar. These forms allow you to:

• Update clinical staff

• Update locations (open or closed)

• Indicate if you are accepting new patients

• Indicate if you are board certified

• Indicate practice hours

• Indicate specialties provided

• Provide NPIs - both clinic and staff

• Indicate website URL

• Indicate if you are accepting new patients

So you can see how important it is to keep this information up to date. Imagine if a patient is looking for services and your information is not current - he could show up at a location that no longer exists. Even if you are part of a large network that manages several hundred payers and contracts for you, it is still your responsibility to keep your information updated and complete.

Once you are on the payer website, it's also important to make sure they do not have you listed as "in-network" if you are an "out-of-network" provider. This can be very misleading to patients, and doubled with an untrained front-office staff can cause tremendous grief for the patient (and your practice) if she ends up paying out-of-network rates.

You can find an example of an Anthem Blue Cross form here.

Oftentimes, if you cannot locate a specific form, you can email the payer contract division or provider relations with your current information so they can update their website and database.

It's also wise once you submit this information, to check back in about 30 days to make sure the payer has completed the task. An annual visit to your payers websites is also a great idea for due diligence to insure the information your patients are receiving is still accurate.