The Centers for Medicare & Medicaid Services (CMS) requires that Medicare Advantage (MA) organizations ensure the validity of provider demographic information.
We need to reach out to providers every quarter to validate their information. Our current vendors — CAQH® and Availity® — perform this outreach. And you are obligated, as an MA provider, to comply with this validation.
Have you recently moved your office or changed your phone number, email address or any other demographic information? If so, simply go to our vendors’ websites and update your profile within seven days of the change. Don’t wait for the quarterly attestation process, and don’t call or fax the information to Aetna. We’ll get the update from the vendors and process it.
If you’re not a Medicare provider or if you have not received vendor communications, you can always go to NaviNet®, our provider website. NaviNet users have access to Aetna’s “Update Provider Demographics” function, through which they can submit demographic changes.
We take this compliance obligation seriously. If you don’t reply, we may suppress your information in our directory. This means that patients and providers won’t see you listed as our participating provider. And we may even terminate the participation of providers that don’t comply.
Important message for Massachusetts providers
Starting in November 2018, we expanded our relationship with CAQH to improve our provider directory accuracy. This expanded relationship was necessary to address guidance from both the state of Massachusetts and the Centers for Medicare & Medicaid Services (CMS). Starting this fall, our Massachusetts commercial and Medicare providers will be asked to validate their demographic information quarterly. This new process will help us improve the accuracy of our Massachusetts provider directories. We appreciate your cooperation with this program.