Provider Directory Updates and Required Attestation
As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly).
This allows us to comply with CMS/DHS/PID requirements to maintain accurate directories—as well as the federal No Surprises Act (effective Jan. 1, 2022).
Accurate directories are the primary way our members find in-network care. CMS states, “Plans may not list a provider in their directory if the enrollee cannot call the phone number listed and request an appointment with that provider at the address listed."
UPMC Health Plan quality programs also require provider directory verification as a condition of participation and payment. In addition, failure to attest every 90 days may result in further action per your participating provider agreement. Please note that this does not apply to Premier Partners.
Ways to keep your information current
UPMC Health Plan utilizes CAQH for directory updates and attestation. CAQH will notify you by alerts and contact you via email or telephone outreach to verify and attest that your provider directory information is accurate. If you’re already registered with CAQH, please continue to visit the CAQH Provider Data Portal at https://proview.caqh.org/ to update your information. If you’re a new user, please create a CAQH profile at https://proview.caqh.org/PR/Registration. The CAQH Provider Data Portal will guide you through completing your information, managing your profile data and supporting documentation, and attesting your information.
You can visit the provider directory to ensure that your provider information and office details are up to date and accurate. This is the information that must be reviewed/updated/verified:
- Ability to accept new patients
- Street address
- Phone number
- Office hours
- Hospital privileges
- Telehealth availability
- Any other information that affects your availability to our members
You can view your information by searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change-provider-profile-info.aspx.
If you have any questions, need help with your updates, or need to change your contact information, please contact your physician account executive or email providernetworkinquiries@upmc.edu.
Thank you for your support in this ongoing effort!
CAQH cannot change your product participation or the services contracted by your practice. If you have questions or concerns regarding product participation or contracted services, contact your physician account executive
If you have questions or concerns regarding product participation or contracted services, contact your physician account executive.
Please review your National Provider Identifier (NPI) data in the National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure that accurate provider data is displayed. CMS strongly recommends that providers keep their NPPES data current.