CMS Compliance Reminder
Quarterly Provider Demographics are important in more ways than one.
A response to the Quarterly Provider Demographics Review is required for any changes and must be returned to Provider and Payer Services within five business days from date of receipt.
Per CMS regulations, Section 110.2 of the Medicare Managed Care Manual, payers are required to ensure accurate information for the payers’ directory. Not only is ensuring appropriate practice location information necessary, but it’s also important to make certain the practice information remitted to delegated payers is the most current information at the time of the Quarterly Provider Demographics Review.
As Lehigh Valley Physician Hospital Organization’s (LVPHO) delegated credentialing agreements hold LVPHO accountable for confirming the CMS requirements are met, Provider and Payer Services initiated the Quarterly Provider Demographics Review. This review is distributed to practice managers on a quarterly basis via email (your preferred/primary email provided upon enrollment in LVPHO) requesting the following important items be reviewed:
- Practice Address
- 9 Digit Zip Code (Please verify practice location zip code on the USPS website to ensure that the last four digits have not changed or have been updated by the postal service.
- Practice phone number
- Accepting new patients
- List in directory
For group practices, the payer’s directory must only list individual provider locations where their physicians routinely see patients, not every location in the practice.
A response to the Quarterly Provider Demographics Review is required for any changes and must be returned to Provider and Payer Services within five business days from date of receipt. If a response is not received, it will be assumed that the information emailed to the practice is accurate.
Quarterly Provider Demographics Reviews are critical to ensure that accurate demographic information is delivered to payers. The Reviews are also necessary for LVPHO to meet and exceed its contractual CMS compliance regulations and maintain its delegated credentialing designation.
If you have any questions about the CMS quarterly review, contact Provider and Payer Contract Coordinator Jomarie Wintle at 610-969-1911 or [email protected].