Verify and Update Your Information

When seeking health care services, our members and other professionals trying to make referrals rely on current and accurate information in our online Provider Finder®. 

You can verify and update certain data using the Availity® Essentials Provider Data Management feature or our Demographic Change Form. Select the buttons to access these tools and learn more about the best way to use these tools further below:

Availity Essentials Provider Data Management
Demographic Change Form

Verify Information Every 90 Days

The federal Consolidated Appropriations Act (CAA) of 2021 requires the following directory information be verified every 90 days:

  • Name
  • Address
  • Phone 
  • Specialty
  • Digital contact information (website)

Under CAA, we’re required to remove providers from displaying in our Provider Finder whose data we’re unable to verify.

This data must be verified every 90 days even if it hasn’t changed since you last verified it.

You must update your information when it changes, including if you join or leave a network. If you leave a network, you should continue to update your information immediately and according to your contract terms. If you’re incorrectly identified as an in-network provider in Provider Finder, it may limit member cost-sharing to in-network levels. Learn more about the CAA.

How to Verify Information

Professional Providers

We recommend you use the Provider Data Management (PDM) feature on Availity® Essentials to quickly verify and update information. If you’re unable to use Availity, you may submit a Demographic Change Form. Refer to the User Guides section below for how to use this form for verification purposes.

  • Professional provider groups can verify individual providers through the Availity PDM feature or our Demographic Change Form.
  • Professional provider groups who submit changes by roster can verify all their providers’ information every 90 days with their roster. When a group submits a roster, all providers affiliated with this group and not listed with an update are verified as correct with no changes.

Hospital, Facility and Ancillary Providers

Use only the Demographic Change Form to verify data.

How to Make Updates

If you need to change your data, follow the instructions below. Updating your data will count as your 90-day verification. We won’t accept demographic changes by email, phone or fax to enable us to meet the two-day directory update requirement defined by the CAA. Any demographic updates requested through these channels will be rejected and closed. Changes must be submitted electronically unless you have otherwise opted out of conducting business with us electronically; in that case, changes will be accepted by U.S. mail.

Professional Providers and Professional Provider Groups

Use Provider Data Management via Availity to update the following data: 

  • Personal information
  • Service location address change
  • Payment address change and contact information
  • Hours of operation
  • Business website URL

Changes you can make using the Demographic Change Form include:

  • Legal Name
  • NPI/Tax ID
    In-network Providers or Groups – Prior to changing a TAX ID or requesting termination from a provider network, (excluding Par Plan Agreement) contact your Network Management Office Location before completing this form.
  • Email (we can house up to 10 email addresses)
  • Office Service Locations (Address, phone, fax, email and hours of operation are required)
    • Primary Physical Address
    • Directory Location/Satellite Address
  • Other Information
    • Billing Address for group – include W9 and Letterhead from Group
  • Address, phone, fax and email information are required.
    •  Credentialing contact email/fax/phone
    •  Administrative contact email/fax/phone

Electronic commerce information Learn More.

See User Guide section below for assistance.

Note: If a change impacts multiple providers or groups, submit the Demographic Change Form for each provider and/or group provider record number or provider location impacted.

Hospital, Facility and Ancillary Providers

Use the Demographic Change Form rather than Availity to verify and update information. You can update information including:

  • Email (we can house up to 10 email addresses)
  • Service Location Address Email/Fax/Telephone and Hours of Operation. (Submit copy of license with matching address for this location)
  • Other Information
    • Billing Address (Phone, fax, and email are required)
    • Credentialing contact email/fax/phone
    • Administrative contact email/fax/phone

Note:

User Guides for the Demographic Change Form

Setting Up a Provider Record ID

Providers should refer to the Provider Onboarding Process to request a BCBSTX Provider Record ID and contracts if needed.

Case Status Checker

If you have completed a Demographic Change Form or a Provider Onboarding Form, you can check the status by entering the case number you received in your confirmation email in our Case Status Checker.

For the status of your professional contract application, or if you have questions or need to make changes to an existing contract, please contact your Network Management Consultant.