Update Your Info

Keep your provider directory information up to date—we make it easy! 

CMS requires us to regularly contact our network providers to confirm the accuracy of our directory information. Up-to-date directory information helps our members find new providers when they need care and ensures more timely and accurate claims processing.


For a detailed guide, refer to our newly updated Provider Portal User Guide (PDF) | Latest as of October 2023.


Tools for Updating Provider Information

Tips for practice administrators:

  • Create a monthly tickler reminder to check the accuracy of your provider/practice information in Provider DataPoint.
  • We no longer accept NPI-related updates/changes and credentialing applications via email or fax. They must be submitted online via Provider DataPoint.
  • Radiologists, anesthesiologists, and midlevel providers (NP, PA) who do not practice as PCPs do not require credentialing.
  • Please provide 30 days advance notice of changes to your provider/practice information when possible.


There are two online tools you can use to keep your NPI-related practice/provider information accurate:

Provider DataPoint

Please use our web-based provider data management tool to submit real-time changes:

  • Change your practice information, including name, phone/fax, address, billing information, NPI, etc.
  • Add/delete a location to your already-contracted practice/group
  • Change provider information, including name, specialty, panel status, add a language, etc.
  • Add a provider who requires credentialing to your practice. (You do not need to submit Radiologists, Anesthesiologists, Pathologists, Emergency Medicine providers, or midlevel providers (NP, PA) who do not practice as PCPs. These specialties do not require credentialing and will be loaded upon claims receipt.)
  • Terminate a provider from your practice/group
  • Check the status of a previously submitted data change request

Call 1-800-348-9804 to add a new facility (hospital, skilled nursing facility, ambulatory surgical center, etc.). A new participation agreement and/or credentialing application may be required.

Portal Access List Update: To ensure accurate updates to our provider portal, billing organizations must directly email Martin's Point to add Taxpayer Identification Numbers (TINs) to their access lists. Please refrain from using the Provider Datapoint forms for this purpose, as it could impact processing.

Email: [email protected]

Fax: 1-207-828-7870

Mail: Martin’s Point Health Care, Network Management Department, PO Box 9746, Portland, ME 04104

National Plan and Provider Enumeration System (NPPES)

CMS now allows providers to use the NPPES to certify their NPI data. Information and FAQs about using NPPES as a reliable source for provider directory data are available at https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/index.

Please direct questions about the NPPES to Jeremy Willard at [email protected]

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 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.

For Mental Health Providers

If you are interested in participating in the Martins Point network or need to make changes to your information, please contact the Behavioral Healthcare Program (BHCP) at 1-800-538-9698.

You can also visit their website: https://www.bhcp.org/ProviderServices.aspx to download the BHCP Provider Change Form.  


Provider Directory

By updating your information, you are ensuring the accuracy of our provider directory and creating a better experience for our members to search for and find the provider that is right for them.

Please help us maintain an accurate provider directory by checking your provider listing for important information like address, phone number, and panel status.

GENERATIONS ADVANTAGE DIRECTORY

Access the Provider Directory for the Martin's Point Generations Advantage plans.

US FAMILY HEALTH PLAN DIRECTORY

Access the Provider Directory for the Martin's Point US Family Health plan.

Group Contact Information

By providing Martin’s Point Health Care with this information, your group will receive important updates and changes in a more timely and effective way.

In order to better communicate with your group, Martin’s Point is now collecting contact information for the following roles:

ROLE
COMMUNICATION DESCRIPTION
Administrative Authorization and Referral Updates
Billing Claim and Payment Policy Updates
Clinical Medical Policy Updates
Contracting Contract Notices and Updates
Credentialing Credentialing and Delegation Updates
Executive Performance and Quality Updates
Financial Performance Updates
Population Health  Quality Updates
Practice Manager
General Notice Updates
Provider Data
Requests for Demographic Updates
Reporting
Report Delivery
 

HAVE QUESTIONS? GET IN TOUCH WITH US

If you have questions about updating your provider information or related items, contact the Martin's Point Network Management department below.

You can also find more information in the Provider Manual.

nurse on phone with patient