22-860m Update and Certify Provider Data in CMS's National Plan & Provider Enumeration System (NPPES)

Date: 10/12/22

This is a legal requirement

For your benefit as a valued physician and other provider partner, we encourage you to review your National Provider Identifier (NPI) data in the National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure its accuracy. Keeping NPPES data current is a legal requirement for physicians and other providers.

We can contact you less frequently

The Centers for Medicare & Medicaid Services (CMS) encourages Medicare Advantage Organizations to use NPPES as a resource for our online provider directories. NPPES enables us to contact you less frequently for updated directory information and provide Medicare beneficiaries with more reliable information.

This information is a resource for provider directories

When physicians and other providers keep the NPPES database up to date, our organization can rely on it as a primary resource for our provider directories instead of calling your office for this information. We can compare the updated physician and other provider information in the NPPES database with the information in our existing provider directory.

When reviewing your physician and other provider data in the NPPES database, please update any inaccurate information in modifiable fields, including provider name, mailing address, telephone and fax numbers, and specialty, to name a few. Make sure to include all addresses where you actively see patients and where a patient can call to set an appointment. Do not include addresses where you could see a patient but do not actively practice. Please remove any practice locations no longer in use.

Certify updated information in NPPES

Once you update your information, you will need to confirm its accuracy by certifying it in NPPES. Remember, NPPES has no bearing on billing Medicare Fee-For-Service.

If you have any questions pertaining to NPPES, you may reference NPPES help. Please direct any general questions about this notice to your provider relations representative.

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the Provider Services Center within 60 days at 800-929-9224.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.