90-Day Provider Validation Requirements

90-Day Provider Validation Requirements

Provider demographic data can change frequently throughout the year and in our networks.  To ensure our members know where to find the right physicians or facilities for the care they need, it is vital that we validate the accuracy of their contact information regularly. As part of the No Surprises Act, set to go into effect on Jan. 1, 2022, providers are required to verify and/or update their demographic data at least every 90 days. This includes both individual physicians and facilities.

Validations should be completed using M.D. Checkup which is in My Insurance Manager℠ (MIM) and will be determined based on the number of days since the last validation was made. If more than 90 days has passed since the provider’s last validation, we are required to remove them from our directories.

M.D. Checkup can also be used if updates are needed. Once the changes have been made, we will have our directories updated with the new data within 2 business days of receipt.

If you have any questions about this bulletin, please contact Provider Education using the Provider Education Contact Form located on www.BlueChoiceSC.com.