Is Your Provider Directory Information Still Accurate?

An accurate and up-to-date online provider directory is essential for Highmark members seeking care. To maintain the accuracy of our provider directory, we ask that you verify your information every 90 days.

Why is this important?

• Compliance – The Centers for Medicare and Medicaid Services (CMS) mandates quarterly validation of provider directory data.
• Accuracy – Validated data ensures correct claims processing and helps members find the right care.
• Network Status – Failure to validate data quarterly may result in removal from the directory and impact network status.

What to Review

Please verify the following information for each practitioner:

• Full name (matches medical license)
• National Provider Identifier (NPI)
• Practice name (matches phone greeting)
• Accurate list of current specialties
• Confirmation that practitioners see members and schedule appointments regularly at listed locations and are affiliated with the group.
  • Exclusion: Do not include covering physicians, those reading test results, or hospitalists.
• New patient acceptance status (accepting or not accepting)
• Correct address, suite number (if applicable), phone number, email, and website address.

How to Verify Your Information

• Professional Providers: Use the Provider Data Maintenance (PDM) tool within the Availity Essentials provider portal every 90 days.
• Facility and Ancillary Providers: Use the Highmark Facility/Ancillary Change Form here on the Provider Resource Center every 90 days.

Important Reminder

Double-check your email address(es) during the attestation process to guarantee uninterrupted communication.