Attention! An update has been made to this
If information in the Independence provider directory is incorrect, it has a
negative impact on our members. Therefore, it is critical that you regularly
review your demographic information in the provider directory to ensure that
all of the information is accurate.
In compliance with new guidance issued by the Centers for Medicare &
Medicaid Services (CMS), Independence is working to ensure the accuracy of our
provider directory. To support the success of this important initiative, we
need your participation.
Review your provider information
Provider offices should review their demographic information published in
the provider directory on a quarterly basis. You can view your current listing online using the Find a Doctor tool (i.e., online
Please be sure to address the following questions when reviewing your
provider demographic information:
- Can members make an appointment with the practitioner at the location for
which he or she is listed?
- With which plans is the practitioner currently participating?
- Is the practitioner accepting or not accepting new patients at the location
- Is the practitioner specialty (e.g., primary care physician, cardiologist,
oncologist) accurate for the location listed?
- Can members use the phone number listed for the location to call and make
- Are the names for the practitioner and practice correct?
In addition to accuracy checks being conducted by CMS based on the
information found in our provider directory, you may also be contacted by
Independence to verify the accuracy of this information. Independence may
request verification of this information via fax or phone audit.
Educating office staff
It is essential that staff members in your provider office are educated
about the practice or facility. Please note the following important
- Health plan participation. Educate office staff about
which Independence health plans are accepted at your practice, as it is
imperative that all staff can answer this question for members calling for an
appointment. For example, be sure that the office staff is aware of the
provider?s participation status for plans like Keystone 65 Focus Rx HMO, which
uses a defined network.
- Location affiliations. Ensure that the front and back
office staff members are educated about all providers seeing patients at your
practice location. Providers must only be affiliated with locations where they
are seeing patients and scheduling appointments. Claims adjudication will occur
regardless of office location, as long as the provider is affiliated with your
- Consistency across all office staff. Ensure that the front
and back office staff members are educated about important provider office
details, such as whether new patients are being accepted and the health plans
in which the provider participates.
How to update your information*
As changes become apparent in your practice or facility, you are required
to communicate those changes to Independence. As outlined in the Administrative
Procedures section of the Provider Manual for Participating Professional
Providers (Provider Manual) and the Hospital Manual for Participating
Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital
Manual), Independence requires 30 days advanced notice to process most
- updates to address, office hours, total hours, phone number, or fax
- changes in selection of capitated providers (HMO primary care physicians
- addition of new providers to your group (either newly credentialed or
- changes to hospital affiliation;
- changes that affect availability to patients (e.g., opening your panel to
For more details about requirements for keeping your provider information up
to date, please refer to the Administrative Procedures section of the
Provider Manual or Hospital Manual, as applicable.
Failure to comply with regulations or provide
Per your Independence Professional Provider Agreement and/or Hospital,
Ancillary Facility, or Ancillary Provider Agreement, providers are required to
comply with all applicable local, state, and federal laws, rules, and
regulations to the extent that they directly or indirectly affect the provider
Independence will not be responsible for changes not processed due
to lack of proper notice. Failure to provide proper advanced written notice to
Independence regarding provider changes may delay or otherwise affect provider
payment and your designation in our provider directory. Lack of designation in
the provider directory would inhibit members from selecting your practice or
facility for care.
Thank you in advance for your participation in this important effort to
ensure that our members have access to the most current information about our
provider network. If you have further questions, please contact your Network
providers contracted with Magellan Healthcare, Inc., an independent company,
must submit any changes to their practice information to Magellan via their online Provider Data Change form by selecting the “Display/Edit
Practice Info” link.
Magellan Healthcare, Inc.,
an independent company, manages mental health and substance abuse benefits for
most Independence Blue Cross members.