The Consolidated Appropriations Act (CAA) requires participating providers to keep us informed of changes to their provider directory information. The CAA also requires health plans to verify and update their provider directory information every 90 days. Note: Third-party organizations are exempt from this requirement.
To meet this verification requirement, providers need to review their provider data every 90 days and validate that the information listed is correct. The 90-day requirement is based on the date of your last validation. Note: If a change is identified through our internal automated validation process, you may see an updated validation date displayed. This internal validation will reset your 90-day time frame.
Validate your data
Use the Provider Data Maintenance transaction in PEAR Practice Management on the PEAR portal to complete your review and validation. Please use Google Chrome or Microsoft Edge when accessing the tool.
The Messages section will show your last validation date and your next due date:
Review the Provider Data Maintenance user guide on the PEAR Help Center for step-by-step instructions.*
If you have multiple locations, we recommend you coordinate this effort and designate someone to complete the review and validation on behalf of your organization.
*Behavioral health providers contracted with AmeriHealth HMO, Inc. or AmeriHealth Insurance Company of New Jersey on or after January 1, 2023, are required to review and validate their information using the Provider Data Maintenance tool. Behavioral health providers contracted with Magellan Healthcare, Inc. (Magellan) are required to notify Magellan and/or confirm any changes in administrative practice information via Magellan's online Provider Data Change form by selecting the “Display/Edit Practice Info" link. For questions, Magellan-contracted providers can contact the Magellan Provider Services Line at 1-800-788-4005.
How this mandate affects you and your patients
Per the federal mandate, if a provider's data is not validated every 90 days, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) are required to suppress the provider from appearing in our provider directory (online Find a Doctor tool) until the provider's information can be confirmed. Once you complete the validation process, your provider data will reappear in the provider directory within two business days.
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.
Important impact: 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).
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.
For questions on completing the validation process, please contact PEAR Support at
1-833-444-PEAR (1-833-444-7327).
Thank you for helping us keep accurate provider records and complying with this mandate.