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Demographic Updates and Practitioner Telephone Numbers

It’s important that the information we display within our Doctor & Hospital Finder is current and accurate so that our members can easily locate you and access the care and services they need from you.

To ensure that the information we maintain about participating practices, doctors and other health care professionals is accurate, current and complete, we require that participating providers make appropriate and timely updates to their information on file with us.

Phone numbers that are displayed as part of a doctor’s or other health care professional’s profile within our Doctor & Hospital Finder should always be the phone number that a member can call to schedule an appointment with that practitioner at that practice location.

It is not appropriate to include other phone numbers (i.e., direct lines to practitioners or their assistants, lines to main switchboards that do not schedule appointments, etc.).

Please ensure that the phone number(s) within your provider profiles are the appropriate number to schedule appointments with you at that practice location.

If you have questions, please contact your Network Specialist.


How to convey demographic updates to us

CAQH
The easiest way to ensure that practitioner information is current, accurate and complete is to use CAQH Proview.

Using CAQH Proview eliminates the need for you to share the same professional and practice information with all the health insurance plans with which you work. Simply create and maintain a single CAQH Proview profile – at no cost to you – and grant access to organizations you select for purposes of claims administration, credentialing and directory services.

If you’re not already registered in CAQH ProView, visit ProView.caqh.org/pr to self-register.

If you have an existing CAQH ProViewTM profile...

  1. Review your current information in the Provider Directory Snapshot
  2. Make updates to your information and affiliations, as appropriate, paying specific attention to:
    • The office locations at which you practice
    • If you’re currently accepting new patients
    • Degree(s) earned
    • Specialty
    • Email address
    • Gender
    • Hospital affiliation(s)
    • Language(s) spoken
    • Phone number(s)
    • Fax number(s)
    • NPI information
  3. Re-attest that this information is current, accurate and complete and may be included in files and published in directories for the health plans you designate.

We recommend that you thoroughly review the information within your CAQH Provider Directory Snapshot before you re-attest that your information is current, accurate and complete and may be included in files and published in directories for the health plans you designate.

Information omitted from your CAQH ProViewTM profile might result in our making changes to your Horizon BCBSNJ provider file. For example, if you re-attest that your CAQH information is current, accurate and complete, but your profile only includes three of the five locations at which you practice, Horizon BCBSNJ will “end date” your affiliations at those omitted locations.

Provider File Change Request Form
You may also initiate changes to practitioner and practice-level demographic information by submitting a completed copy of our Provider File Change Request Form (9093) along with all necessary supporting documents (e.g., W-9, NPPES Letter, SS4, etc.). Information may be faxed to 1-973-274-4302 or mailed to:

Horizon BCBSNJ Network Management
Three Penn Plaza East, PP-14C
Newark, NJ 07105-2200

Published on: August 28, 2017, 10:02 a.m. ET
Last updated on: August 28, 2017, 10:30 a.m. ET