Network Notes
Keeping Provider Practice Data Current –
A Huge Job That Is Hugely Important
Accurate demographic information is critical to Magellan’s core activities – making appropriate referrals and paying claims accurately. Magellan’s Provider Network department maintains the addresses and other demographic information for nearly 100,000 participating providers. We count on you to notify us when an address, phone number or other demographic information changes, however, we also take great pains to proactively elicit current demographic information from providers.
Here are some of the activities in which the Magellan Provider Network department engages regularly to assure that provider data is current:
- Proactive updates from providers – We encourage providers to submit changes to their demographic and practice information directly on www.MagellanHealth.com/provider. (After signing in, select “Display/Edit Practice Information.”) This is the quickest and most efficient method for updating information. An alternative method is to fax updates to the Provider Data Management department at (314) 387-5584.
- Annual request for updates – Once a year, on the anniversary of each provider’s most recent credentialing date, we send a letter asking the provider to update demographic information on a Provider Data Change Form. This can be done via the Web or hard copy. We send the letter to an average of 2,050 providers every month (excluding providers who’ve sent us a recent update or whose re-credentialing date is within three months).
- Query of postal data – Through the U.S. Postal Service, we regularly identify out-of-date and invalid addresses. We then follow up with the provider to verify corrections.
- Re-credentialing – Magellan is fully accredited by the National Committee for Quality Assurance (NCQA) as a Credentials Verification Organization. We verify demographics at each re-credentialing event. Thus far in 2008, we have re-credentialed an average of more than 1,400 providers per month.
To date in 2008, we have processed an average of 8,400 provider data changes per month, with 97 percent of these changes being processed within five days of receipt.
Please help us keep your information current. Remember to contact us whenever any information changes, including:
- Ability to accept Magellan referrals
- Practice address
- Telephone number
- Licensure or certification
- Members who have joined or left your group
- Hospital privileges
- Malpractice insurance coverage
- Changes in status of malpractice actions
- Taxpayer Identification Number.