Claritev Demographic Update Requirements: What Physicians Need to Know to Stay Compliant
Keeping your practice information up to date is no longer just an administrative task—it is a legal and operational necessity. With stricter enforcement of requirements from the Centers for Medicare & Medicaid Services (CMS) and the No Surprises Act (NSA), healthcare providers must regularly verify and maintain accurate directory listings to remain compliant and accessible to patients.
Claritev has released updated guidance and tools to support practitioners in this process. Whether you’re a solo provider or part of a group or facility, failure to maintain current data can result in network exclusion, delayed reimbursements, or patient complaints. Below is a concise breakdown of what’s required and how to comply.
Why This Matters
Federal regulations now require insurers and third-party administrators to verify provider directory information every 90 days. If you do not actively confirm or update your data, you may be suppressed from directories or flagged for non-compliance. This can limit patient access and disrupt referrals and billing.
Claritev’s Approved Methods for Updating Demographics
Claritev provides multiple channels for providers to update demographic information. Each is tailored to specific types of providers and organizational structures:
1. Online Self-Update via Claritev Provider Portal (Recommended)
Eligibility:
Individually contracted practitioners
Group practices in Commercial and Medicare Advantage networks
(Note: Facilities are currently not eligible for this method.)
Navigate to the “View Provider Demographics” section
Follow the step-by-step instructions in the User Guide under “Help & Resources.”
Why Use It:
Updates made through the portal are processed in near real time and provide the most efficient way to meet the 90-day verification requirement.
2. Electronic Provider Response Form
This online form provides an alternate, streamlined option for eligible providers to submit demographic updates.
Access the form:
Use the QR code in the original Claritev message or click here for direct access.
3. Email or Fax Submission (All Provider Types)
This method is available to all provider types, including hospitals, clinics, and ancillary facilities, across both Commercial and Government lines of business.
Requirements:
Use official letterhead or submit a signed group roster
Ensure the documentation includes complete and current data
To ensure compliance with CMS and NSA requirements:
Identify who in your practice or organization is responsible for demographic maintenance
Confirm the last date your data was verified or updated
Use one of the approved methods to confirm or correct your information
Set a calendar reminder to review and update at least once every 90 days
Failure to Comply Carries Real Risks
Providers who do not maintain updated information risk:
Being removed or hidden from directory listings
Delays or denials in patient referrals
Payment issues due to invalid network participation
Non-compliance with federal regulations, potentially leading to audits or fines
Demographic accuracy is no longer optional—it’s part of the compliance and care delivery infrastructure. With regulatory timelines tightening and payer oversight increasing, proactive updates are a simple yet powerful way to protect your professional standing and ensure patients can find and reach you.
Claritev has provided multiple tools to simplify the process. Use them to stay visible, credible, and compliant.