Here’s what you need to know about providing up-to-date demographic data

At Blue Cross Blue Shield of Michigan, we’re continually working to improve the quality of information in our provider directories.

Members need to know how to get in contact with physicians who participate with their insurance plan and where practices are located. All insurance plans are tasked with providing accurate, up-to-date physician information to members.

In fact, last year, the Centers for Medicare & Medicaid Services mandated that Medicare Advantage health plans provide complete and accurate information regarding physicians to members. If a plan fails to provide accurate provider directories, it’s subject to compliance or enforcement actions, including civil monetary penalties and Medicare star ratings or enrollment sanctions.

Here are answers to some frequently asked questions:

What are Blue Cross and Blue Care Network doing to make it easier for providers to attest to their demographic data?
Currently, we’re using Atlas System’s PRIME-Hub online tool to collect practitioner attestations. However, we’ll be transitioning to DirectAssure™, a CAQH Solution^® in mid-2017. DirectAssure will work in concert with CAQH’s ProView^® program to improve provider directory data. Our goal is to help you avoid frequent outreach for the same information by multiple health care plans, which could create a significant burden on your staff’s time and resources.

Through DirectAssure^®, Blue Cross and BCN providers can confirm their directory information in one place, where it can be shared with participating health plans and will meet our quarterly directory attestation requirement. We’ll incorporate the DirectAssure^® information into our provider files to give our members the most up-to-date, accurate information.

What do Blue Cross and BCN providers need to do this year?

For the first half of 2017 (until we transition to DirectAssure), all providers will need to attest to their current demographic data through Atlas System’s PRIME-Hub tool. For details, see the June 2016 Record article.

What do I do if my demographic information is incorrect in PRIME-Hub?
To update your demographic information, go to the Enrollment and Changes section of bcbsm.com/providers.

How should I prepare for the move to CAQH’s DirectAssure?
We strongly recommend you continue to update your directory information in CAQH ProView (see July 2016 Record article) to help ensure a smooth transition when we adopt DirectAssure mid-year.

What happens if I fail to comply?
Consistent attestation noncompliance by individual physicians will result in such actions by Blue Cross Blue Shield of Michigan as suppression from our provider directories and suppression of value-based reimbursement for physicians who participate in the Physician Group Incentive Program. If non-compliance continues, you could be terminated from Blue Cross and BCN networks.

For PGIP participants only:

Is there any additional information that providers who participate in the Physician Group Incentive Program need to know about?
Yes. To help ensure compliance, Value Partnerships recently launched an incentive opportunity known as the Provider Directory Data Quality Compliance Program. PGIP physician organizations can elect to submit physician demographic data electronically, thereby bringing their affiliated physicians into compliance. An electronic submission from the physician organization would serve as the attestation on behalf of the practitioner.

For the first half of 2017, PGIP participants will want to confirm with their PO whether it is participating in the Provider Directory Data Quality Compliance Program and will be submitting physician demographic data electronically on your behalf. If your PO isn’t participating in the electronic file submission, you must attest to your current demographic data by using the PRIME-Hub online tool and then DirectAssure later in the year.

For more information, PGIP participating physicians can contact their PO. Non-PGIP physicians, contact your provider consultant.