1 LexisNexis Provider FAQs Get straight answers to your questions about the provider verification request faxes or phone calls. More than 25 percent of health care provider contact information changes each year, which is why so many companies need help keeping the information up-to-date. When provider information is accurate, claims are processed more effectively, payments to health care providers are made more quickly, and important communications are received rather than being re-routed. If you ve recently received a fax, or call from the LexisNexis health care division requesting provider information, we d like to take this opportunity to explain why we contacted you and why it s so important that we get your information right. Click on a question below to be taken directly to the answer: Background Who is LexisNexis? Why are you contacting me? How do I benefit from being included in the LexisNexis database? How did you get my information? What are your data sources? Which source provided my information? Who uses this information? And why? What health organizations want my updated information? You keep calling me, but you don t leave a message. Why? Will it cost me anything to have my information verified? How can I contact you? We have additional providers in our office who did not receive a data verification profile. Can we add them to your database?
2 The name on the letter we received is not a provider practicing at my location. What do I do with this information and letter? The provider on the data verification profile is deceased. How do I indicate that in the data verification profile form? The provider on the data verification profile is retired. How do I indicate that in the data verification profile form? The name on the data verification profile form is not my proper name. Where did you get that version of my name? I do not recall giving LexisNexis permission to use my information. Why are you using my data? How can I opt-out of receiving future faxes? What would be the consequences if I choose to opt-out? I d prefer to mail my provider verification form. Where can I send it? You sent a fax to my home. Why? Why don t you use CAQH to verify my data instead? How does LexisNexis keep my data safe? Where is LexisNexis located? How can I find out more? Background The LexisNexis customer base includes health insurance plans, preferred provider organizations, pharmacy network companies, pharmacy benefit managers, property and casualty insurance carriers, retail pharmacies, government entities, as well as life sciences companies (pharmaceutical and medical device manufacturers). Our customers maintain contact databases of every health care provider with whom they do business. These records include your contact information; specifically practice address, phone and fax numbers, and related key identifiers such as National Provider Identifier (NPI) numbers and state license numbers. Using this information, our customers can pay claims and medical bills submitted by health care providers, maintain provider directories for members to find an in-network doctor, communicate patient prescription information and notify providers of important notices, such as product recalls, prescription renewals or other important information. The problem is that each year, many health care providers move, change their telephone numbers or addresses, change their professional status (e.g., retire), or records become inaccurate through human error. It s a challenge to our customers to keep this information accurate and up-to-date and it results in missed communications, slowed or even late payments to you, incorrect information about you on provider directories, and more. According to the U.S. Postal Service, at least percent of the demographic/contact information for health care providers changes every year. In fact, bad or outdated provider data costs the health care industry $26 billion annually. That s why responding to our phone call, fax or requesting verification of your information is so important. Every year, LexisNexis attempts to contact health care practitioners to verify demographic information regarding your office location(s). By taking a few minutes to verify that your practice information is current, your information can be promptly updated in our database. So please read on to better understand why it s so important that we get your information right. Below are commonly asked questions and answers about what we do and why. If you have additional questions, please contact us at (612) or
3 Who is LexisNexis? LexisNexis maintains a portfolio of health care solutions, some of which are focused on monitoring and reporting of health care provider information for our clients. We solve health care s provider information problem, delivering correct, current and comprehensive provider information solutions by blending thousands of data sources, advanced analytics, and health care expertise. As a result, we have compiled the largest, most accurate database of medical provider business and professional demographic data in the United States. At LexisNexis, we help our clients improve results in many areas, including claims processing, provider directories, and regulatory compliance. As the health care industry realigns and consolidates due to initiatives designed to control costs and improve quality of care, the need for correct, complete and comprehensive provider data has become critical. The nation s largest health insurance plans, preferred provider organizations, pharmaceutical manufacturers, medical device manufacturers, and pharmacy network companies count on LexisNexis. To learn more about LexisNexis, click here. Why are you contacting me? If we have faxed or ed you, it is because we need to verify that your fax is secure and can be used for transmitting PHI communication. The American Recovery and Reinvestment Act of 2009 (ARRA) requires that all Personal Health Information (PHI) communication, including prescription renewal requests, must be secure. It s important that you review and confirm or update the provider name, address, phone, fax and any other information included on the form. If we have called you, we simply want to verify that you are practicing at a location we have listed for you in our database. We want to ensure that the address, phone and fax are correct for that location. Once your information is verified, we can pass it back to our customers, so they can accurately pay claims, maintain provider directories, or communicate with you regarding such things as prescription renewals. How do I benefit from being included in the LexisNexis database? By taking a few minutes to verify your practice information with us, we ll be able to confirm that the data about you is accurate, which will reduce the number of phone inquiries you receive from various health care business entities trying to update this information. If needed, we will make corrections or updates to your record in our database. With your help, our customers can pay claims and medical bills more quickly, assure that your address and contact information on health care provider directories and prescription renewals is accurate, and ensure important correspondence is sent to your current address. How did you get my information? What are your data sources? LexisNexis uses over 1,000 authority sources for the information in our Master Provider Referential Database (MPRD ). Powered by AcuSync, a proprietary technology developed by LexisNexis, we continuously inspect and update every detail of the 6.5 million provider profiles in our database. The authority data sources that we employ to verify information
4 about providers in our database include public information, such as state license records, DEA and NPI numbers, zip codes and more. We also use verified commercial information and proprietary data. This information is thoroughly scrutinized before it is accepted for use in our database. In addition, LexisNexis performs more than five million telephone calls, faxes or other type of outreach each year to U.S. health care providers, to further verify the accuracy of our database. Which source provided my information? It is likely that your information was obtained from multiple sources, including those noted in the answer above and data files submitted by our customers. Who uses this information? And why? Accurate and up-to-date provider information is essential for our customers, including health insurance companies, PPOs, pharmacy network companies, pharmacy benefit managers, select property and casualty insurers (typically workers compensation and automobile insurance carriers), life sciences companies, and other similar health care-related businesses. Our customers need accurate provider demographic information that is continuously monitored and updated to run their operations more efficiently, to help assure your practice is promptly reimbursed for services rendered, and that information about your practice and providers is correctly maintained in health care provider directories used by health insurers, health insurance exchanges and preferred provider organizations. Simply put, LexisNexis is much better equipped to monitor changes to provider information than each of our customers are individually. Our customers use provider information in a variety of ways, including communicating patient prescription data, validating provider identity for claims payments, reimbursing providers for medical bills, updating provider directories, renewing prescriptions, researching health care practitioners to invite them to become part of a provider network, sending important notifications, such as product recalls, and other uses. What health organizations want my updated information? Our customers include health insurance companies, PPOs, pharmacy network companies, pharmacy benefit managers, select property and casualty insurers (typically workers compensation and automobile insurance carriers), life sciences companies and other similar health care-related businesses. These organizations license data from LexisNexis to validate provider identify and directory listings, improve claims data, increase operational productivity and more. You can learn more about LexisNexis and its array of provider data solutions here. You keep calling me, but you don t leave a message. Why? If we have tried to reach you on more than one occasion and have not left a message, we apologize for any frustration this may have caused. Unfortunately, our call center does not accept inbound calls at this time, so we must attempt
5 subsequent calls until we can reach you. Will it cost me anything to have my information verified? Not at all! There are no costs to any provider who wishes to validate their demographic information with LexisNexis. How can I contact you? You can reach LexisNexis via fax, or regular mail: FAX to LexisNexis at (866) Mail to LexisNexis at: LexisNexis Attn: Provider Data Verification Team 510 First Avenue North Suite 520 Minneapolis, MN We have additional providers in our office who did not receive a data verification profile. Can we add them to your database? Gladly! Please send us the information for these providers, including their name, practice address, practice telephone, practice fax and NPI number, via FAX to LexisNexis at (866) or This will help us match our records with the additional providers at your location. The name on the data verification profile is not a provider practicing at my location. What do I do with this information and form? If you receive a letter regarding a provider who no longer practices at your location, the information may simply be outdated. That s one of the key reasons why it s so important to continuously verify that the provider information in our database is correct and current. Please return this fax stating the provider is not practicing at this location, and we will update our records. Faxes can be sent to LexisNexis at (866) , or
6 The provider on the data verification profile is deceased. How do I indicate that in the data verification profile form? Please mark on the data verification profile form that the provider is deceased and, if possible, include the month and year when the provider was deceased. Then, please fax the form to LexisNexis at (866) , or lexisnexis.com. The provider on the data verification profile form is retired. How do I indicate that in the data verification profile form? Please write on the data verification profile form the provider is retired and, if possible, include the month and year when the provider retired. Then, please fax the form to LexisNexis at (866) or The name on the data verification profile form is not my proper name. Where did you get that version of my name? The name shown on the form you received is the name we have for you in our provider database. Please submit the corrected form with the name as you would like it to appear. You may fax the form to LexisNexis at (866) , or and we will update your records with your correct name. I do not recall giving LexisNexis the permission to use my information. Why are you using my data? LexisNexis s commercial database of health care providers is made up of information that is in the public domain. Likewise, our provider data verification program validates information from the public domain. We do not share any nonpublic information with the organizations that are licensed to use our data. How can I opt-out of receiving future faxes? To be placed on our Do Not Fax list, you may call (612) to contact the support desk or lexisnexis.com to opt-out. Or, you may write Do Not Fax on the form we sent you and fax it back to (866)
7 What would be the consequences if I choose to opt-out? By choosing to take a few minutes to verify your practice information with LexisNexis, we will make any corrections that you request about your record in our Master Provider Referential Database. This ensures your provider information is kept correct and current, which means the medical bills you remit to our customers will be paid promptly, and that up-to-date information about you and your practice appears in our customers health care provider directories, which can help to drive more business to you. However, if you opt-out of receiving future faxes from LexisNexis, the demographic data that our customers need to communicate with you may quickly become outdated. Health care-related organizations need to have correct and current data about you to pay claims promptly, send correspondence to your current address, renew prescriptions, and publish accurate provider directories. If you choose to opt-out from participating in our provider data verification program, you put yourself at risk for these, and other health care-related business activities that rely on accurate provider data. How do I get a data verification profile form re-faxed to me? Call (612) , or us at I d prefer to mail my provider verification form. Where can I send it? If you prefer to mail your provider verification form instead of faxing it, please send it to: LexisNexis Attn: Provider Data Verification Team 510 First Avenue North Suite 520 Minneapolis, MN You sent a fax to my home. Why? It is never our intention to send a fax to your home. If we reached your home fax and it is not a fax used to support your health care practice, then please let us know via fax to (866) , phone at (612) or provider. We will immediately add that fax number to our Do Not Fax list and you will never receive a fax from us at that number again. You may also want to check your NPPES (National Plan and Provider Enumeration System) NPI (National Provider Identifier) information. It s very likely we are using a fax number that you listed when registering for your NPI. In addition, we are also making adjustments to our fax process to regulate the traffic so that faxes will only occur during regular business hours.
8 Why don t you use CAQH to verify my data instead? Typically the CAQH data is only used for credentialing functions. In fact, many health care-related organizations do not utilize the CAQH provider database at all because they are not an organization authorized to credential providers. In addition, the CAQH database does not include all practice location addresses. As a result, it is very difficult for health care organizations to determine if the address they have on file for you is correct and current. How does LexisNexis keep my data safe? LexisNexis takes data security and identity theft very seriously. Our data center is a HIPAA Security, SSAE-16 and SAS-70 Type II certified facility with extensive security controls and protocols in place. Our systems and procedures undergo rigorous annual security audits, and LexisNexis has achieved URAC accreditation. In addition, we only do business with customers and health care organizations demonstrating proven security measures approved by leading accreditation organizations. Where is LexisNexis located? LexisNexis s corporate headquarters is in Alpharetta, GA. However, this customer service office is located in Minneapolis, MN. For further information, visit our Locations page. How can I find out more? We want to thank you for replying to our provider verification faxes or calls. By responding with your approval and/or any corrections, our clients can offer better service to you. Should you have any questions, please contact our support center at (612) , or For More Information Call or visit About LexisNexis Risk Solutions LexisNexis Risk Solutions (www.lexisnexis.com/risk/) is a leader in providing essential information that helps customers across industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced analytics, Risk Solutions provides products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy. LexisNexis Risk Solutions is part of Reed Elsevier, a leading global provider of professional information solutions across a number of sectors. Our health care solutions assist payers, providers and integrators with ensuring appropriate access to health care data and programs, enhancing disease management contact ratios, improving operational processes, and proactively combating fraud, waste and abuse across the continuum. LexisNexis, and the Knowledge Burst logo are registered trademarks of Reed Elsevier Properties Inc., used under license. Other products and services may be trademarks or registered trademarks of their respective companies. Copyright 2015 LexisNexis. All rights reserved.