Provider directories are an important resource for health care consumers, who utilize them to select providers, make appointments, and access care. In accordance with the No Surprises Act of 2021, providers should review and revalidate their information every 90 days to ensure accuracy of the Provider Directory. Failure to review and update information at least quarterly may result in directory suppression until such information is validated.
On at least a quarterly basis, providers should make sure to review and verify the accuracy of their information displayed in our Harvard Pilgrim Health Care and Tufts Health Plan provider directories (including practice location, phone number, hours of operation, ability of each individual provider to accept new patients, and any other information that affects the content or accuracy of the directories).
Changes to data should be reported via the CAQH Provider Data Portal (formerly known as CAQH ProView) for those who have implemented it.
If your practice has not yet implemented CAQH, please report changes to demographic data to Harvard Pilgrim and/or Tufts Health Plan by:
- Submitting a Provider Change Form to Harvard Pilgrim’s Provider Processing Center for Harvard Pilgrim products by email at [email protected], or;
- Submitting a Medical or Behavioral Health Provider Information Form to [email protected] for Tufts Health Plan commercial or Senior Products or to [email protected] for Tufts Health Public Plans products. (For Rhode Island commercial products, please use the following email box: [email protected].)
(Please keep in mind that if your practice participates in both the Harvard Pilgrim and Tufts Health Plan provider networks, you will need to report demographic data changes to both plans as identified above.)
If Point32Health identifies potentially inaccurate provider information in the directories, we may outreach to your practice to validate or obtain accurate information. If we are unable to obtain a timely response, the provider record may be subject to suppression in the directories until up-to-date information is received.
Reminder: new attestation form for Harvard Pilgrim-contracted facilities
As we announced previously, there is also a new attestation form available for facilities on Harvard Pilgrim’s secure provider portal, HPHConnect, which allows facilities to confirm that their information is accurate every 90 days to avoid directory suppression. For step-by-step instructions on how to complete the attestation form, please refer to the Completing the Provider Attestation User Guide.
Additional information
For additional information, please refer to the updated Directory Accuracy and Suppression of Unverified Provider Information policies for Harvard Pilgrim commercial plans and Harvard Pilgrim StrideSM (HMO)/(HMO-POS) Medicare Advantage plans.