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• Learn how to use electronic solutions for web authorizations, claims submissions or checking member eligibility. • Provide recommendations for enhancements to VHP’s participating provider network to maintain consistency with specialist, ancillary and post stabilization referral and utilization preferences and practices. Another key responsibility of the Provider Relations Department is to continuously monitor network adequacy to ensure that VHP members have access to care that mirrors community access standards and to maintain compliance with VHP and DMHC access standards. Your PRS will keep you and your staff apprised of network changes, provider additions or terminations, or to discuss your needs for specific types of providers within the geographic area you serve.
Notification of Practice or Demographic Change Requirements To help VHP maintain an accurate Provider Directory and claim payments, it is important that you or your designated office staff proactively notify your PRS at least 30 days prior to any changes to your practice. You can access the Provider Directory Online Verification and Change Form on VHP’s website using the following link: www.valleyhealthplan.org/sites/p/Pages/Provider-directory-change-form.aspx For more routine demographic changes, you or your office staff can access the Provider Directory Online Verification and Change Form on VHP’s website using the following link: www.valleyhealthplan.org/sites/p/Pages/Provider-directory-change-form.aspx Examples of the types of information providers must submit to VHP to allow for the verification and maintenance of VHP’s Provider Directory include: 1. The provider's name 2. The provider’s practice location or locations 3. The provider’s contact information 4. The provider’s office hours by day of the week 5. Type of practitioner (PCP, Specialist, etc.) 6. NPI 7. California license number and type of license 8. For physicians, the American Board of Medical Specialty designation and subspecialty, including board certification, as applicable 9. For advanced practice providers, specialty designation, including any board certification
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CH 2: Resources for Providers
2021 / Provider Manual
