Demographic Updates

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.

If our files are not accurate, current and complete, our online Doctor & Hospital Finder will not provide the information members need to locate you and access the care and services they need from you, nor will other participating providers locate you when seeking to refer their Horizon BCBSNJ patients to other in-network practitioners and providers.

Accurate demographic information also reduces the potential for delayed/denied payments resulting from inconsistent or incomplete information and helps ensure that you receive payment and other vital notices in a timely manner.

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.
    • E-mail 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.

While the CAQH process is easy to use, please be thorough when you 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

TIN Changes and Termination Letters

To make us aware of changes to your practice’s Tax Identification Number (TIN), including TIN mergers, or a decision to terminate your Agreement(s) with us, please fax a letter to the attention of your Network Specialist at 1-973-274-4302.

Nonparticipating Provider Demographic Information

Nonparticipating practices, doctors and other health care professionals may update their demographic information by faxing updated information to 1-973-274-4101 or mailing information to:

Horizon BCBSNJ
3 Penn Plaza East, PP-14C
Newark, NJ 07105-2200