As a participating provider, the Consolidated Appropriations Act (CAA) requires you to keep us informed of changes to your provider directory information. The CAA also requires health plans to verify and update their provider directory information every 90 days. To meet this verification requirement, providers need to review their provider data every 90 days and attest that the information listed is correct. Note: Third-party organizations are exempt from this requirement.
We have created a new tool in PEAR Practice Management (PM) to help you easily review and attest your data. As the launch of this tool was delayed, you will see a due date of April 1, 2022, displayed in the tool. We ask that you review and attest your data as soon as possible to remain compliant.
Per the federal mandate, if a provider's data is not validated every 90 days, AmeriHealth is required to suppress the provider from appearing in our provider directory (online Find a Doctor tool) until the provider's information can be confirmed. Due to the tool's delay, we did not suppress any providers from the directory on April 1. Going forward, the 90-day requirement will be based on the date of your last validation. For example, if you attest your data on April 20, the compliance deadlines will continue every 90 days from this date.
How incorrect data affects you and your patients
The mandate is meant to protect patients and improve the accuracy of provider directory information. Our online Find a Doctor tool is used by AmeriHealth members to conduct efficient searches for network doctors, specialists, hospitals, and other health care professionals.
If a member provides documentation to AmeriHealth that they received incorrect information, the member is only responsible for in-network cost-sharing. This means that the provider would need to refund the patient if out-of-network costs are inappropriately applied (in certain circumstances).
How do I review and attest my data?
A new tool, Provider Data Maintenance (PDM), is now available via PEAR PM on the Provider Engagement, Analytics & Reporting (PEAR) portal to assist you in quickly completing this process.* Please use Google Chrome or Microsoft Edge when accessing the tool.
Review the Provider Data Maintenance user guide under Practice Management – Provider Administration on the PEAR Help Center for step-by-step instructions on the process.
You will see the data elements we have on file for your practice or organization that appear in the provider directory.†
- If the information is accurate, you can attest through the tool.
- If changes are required, the tool will lead you through the steps to submit changes.
Once changes are validated, we will update your information in our system within two business days. Our team will contact you if additional information is needed.
If you have multiple locations, we recommend coordinating this effort and designating someone to complete the review and attestation on behalf of your organization each quarter.
*Behavioral health providers contracted with Magellan Healthcare, Inc. (Magellan) must submit any changes to their practice information to Magellan via Magellan's online Provider Data Change form by selecting the “Display/Edit Practice Info" link. If you have questions, please contact the Magellan Provider Services Line at 1-800-788-4005.
†Certain sections apply to professional providers only. For facility and ancillary providers, please select “Yes" to these sections to continue your review as we work to revise the display within the tool.
What happens if I do not attest my data?
Providers are required to verify their data every 90 days from their prior validation. Your last validation date is displayed within the Provider Data Maintenance tool. Note: If a change is identified through our internal automated validation process, you may see an updated validation date displayed. This will reset your 90-day timeframe.
If you do not review and attest your provider data every 90 days, your information may not display in our online Find a Doctor tool (though you will remain in our network). Once you complete your attestation, the directory data and display will be refreshed within two business days.
Questions
If your organization has not yet registered for the PEAR portal, learn more here. In the meantime, you can follow the secondary method outlined on the Provider Data Maintenance page to review and update your provider information.
If you have questions on completing the attestation process, please contact PEAR Support at
1-833-444-PEAR (1-833-444-7327).
Thank you in advance for helping us keep accurate provider records and complying with this mandate.