Protect your network participation! Update provider directories every 90 days, verify carrier calls, and avoid phishing risks. Stay compliant, in-network, and accessible to patients.
Referenced Links:
Provider Directory Verification: Insurers Must Audit Every 90 Days, But Providers Bear the Risk
You May Receive a Call from BCBSIL to Verify Directory Information
In-Network or Out-of-Network… Update Your Directory Info Today
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Transcript:
We’re continuing to get phone calls from our members about provider directory phone calls, questions, and some challenges in staying in network because of the lack of updating provider directory information with various carriers. And so I wanted to make sure that everybody is up to speed. First of all, there are both federal and state statutes that require insurance carriers to keep their provider directories up to date. In fact, the Illinois statute requires that the insurance carriers do an audit to make sure that they are up to date. The way they’re doing the audit is through phone calls.
They’re calling the providers if they haven’t updated. So if providers have updated the directory, you’re okay, and I’m going to touch on that in just a minute. But if you haven’t, you could be getting a phone call. The problem is, the phone calls sure seem like they’re phishing schemes, and of course they’re asking you for pretty private information, even though most of it is public. It’s your name, it’s your phone numbers, it’s your NPI address or NPI numbers. All of those things are public. So they’re asking you these seemingly private questions to update the directory. And of course, it’s putting everybody on alert, and rightfully so, especially in today’s day and age.
If you’re like I am, I get a truckload of spam calls every single day. So I get it. It’s complicated to figure out which is real and which is not. So in this case, here’s what we’re recommending. We want you to go out and just be proactive. You need to update your directory, especially with Blue Cross Blue Shield of Illinois. That impacts the vast majority of the doctors who have this responsibility here in Illinois, the vast majority of our members that have to fill out the information or have to keep their directories up to date. But also, just so you know, when you do get these phone calls, you have to pay very close attention.
Of course, do not give them information that is not public or that you would not share with a patient. I’m not talking about patient information, but specifically with a prospective patient. Maybe that’s a good way to put it. And so your phone number, your NPI number, all of those things, they’re public. In fact, your NPI, you’re actually required to put it even at the top of your good faith estimates. As an example, I can go look up NPI numbers for any provider in the country, actually. So all of those things are public. But, like I said, I know how it feels when they’re making the phone calls, and sometimes it’s hard to understand them.
