Provider Directory—Demographics Updates
Martin's Point Health Care is committed to maintaining an accurate provider directory in order to provide our members with the information they need to choose and contact providers.
This commitment supports requirements from the Centers for Medicare and Medicaid Services (CMS), Defense Health Agency, NCQA, and other regulatory bodies that health plans maintain and update data in provider directories. Martin's Point Health Care relies on providers to review their data and notify us of any changes as they happen to ensure that members have access to accurate information. Federal and applicable state law requires Martin's Point Health Care and providers to work together to maintain accurate provider directories.
Maintaining up-to-date information serves several functions:
- It helps patients find you efficiently. The provider data in our directories helps patients locate care, allows potential new patients to determine if you are accepting new patients, your location, and how to reach you.
- It ensures we have your current information, enabling us to send you timely communications and reminders.
Remember to notify us of any data changes in accordance with state, federal, and contractual requirements and guidelines. Notification of changes to practice locations, availability to see new patients, and other alterations impacting the content or accuracy of the Martin’s Point Health Care directories should be submitted at least 30 days prior to the change.
You can review all your practice information through the Martin’s Point Health Care online US Family Health Plan Provider Directory or Generations Advantage Provider Directory and update any information using the Provider DataPoint Update Tool, which offers a centralized process for providers to report changes to directory data.
Below are the changes that require notice:
Practice, Group, and Facility Changes
Practice, Group and Facility changes that require notice include, but are not limited to:
- Practice name
- Tax Identification Number*
- Billing National Provider Indicator (NPI)
- Address
- Phone number, fax, or e-mail
*Changes in tax ID numbers may require an amendment or new participation agreement depending on the reason for the change. Check with your Martin's Point provider representative for specific information.
Provider Changes
Provider changes that require notice include, but are not limited to:
- Provider information (name, degree, gender)
- Spoken languages
- Specialty**
- Panel status (accepting new patients)
- Hospital privileges
- Adding / removing a provider – provider joining or leaving practice/group**
** If adding a provider or a specialty, in most cases the provider must first be credentialed before rendering treatment to any plan member. Please see the Credentialing page for further detail.
Provider departures are a significant aspect of healthcare management that require careful attention, particularly when the provider serves as a primary care provider (PCP). Ensuring continuity of care for our members is paramount in such situations. When a PCP within our network is terminated, it initiates a comprehensive process to seamlessly transition affected members to an alternative provider. This involves identifying suitable replacement PCPs in our network who can provide the necessary medical services and maintain the continuum of care for affected members.
In navigating provider departures, Martin's Point Health Care prioritizes open communication with both the affected provider and our members to avoid care disruptions. By proactively addressing provider departures and facilitating smooth transitions to new PCPs, we uphold our commitment to delivering excellent healthcare services and fostering positive patient experiences within our network. Additionally, it allows Martin's Point to comply with the regulatory requirements of the Centers for Medicare & Medicaid Services (CMS) and the Defense Health Agency (DHA). To maintain the care that each patient deserves, we ask that you communicate all provider departures at least 30 days in advance of the departure date or as soon as your notification is received.