Help Support an Accurate Provider Directory for Members

Date: 08/21/24

The MHS Health Provider Directory is an integral way for our members to find the care they need in their area, which explains why its accuracy is of utmost importance. The content included in  the Provider Directory is driven by the information MHS Health receives from its provider network.

The following are ways you can help ensure the accuracy of your or your clinic's information in the Provider Directory.

• Supply provider rosters to MHS Health at least quarterly.

• Make note of which practitioners’ locations should be displayed in the directory.
  • A practitioner should only display if a member can call and schedule an appt with that person at the address being provided.
  • The phone number listed should be the phone number to schedule an appointment.

• Identify if the practitioner is a specialist or a primary care provider (PCP).
  • If a practitioner is identified on a roster as a PCP that should display in the directory, they will be assigned members.

• Make note of the practitioners’ panel statuses.
  • Are they accepting new patients or only seeing existing patients? 

• Be sure the specialty/taxonomy on the roster matches NPPES and the State file.
  

 

Not all potential practice locations for a practitioner are required.

• Practitioners are loaded by unique TIN/GNPI combos and added addresses are only needed if they need to display in the Provider Directory
  • If a practitioner is not going to display in the directory (they do not take appointments) only a primary location is needed.
  • If a practitioner accepts appointments, only the locations that take appointments are needed.  However, if they work under additional TIN/GNPI combinations, only the primary locations for the non-directory locations are needed.
    • Example 1: Dr. John Smith takes appointments for and sees patients at 123 Main Street. Twice a year, Dr. Smith may assist with patient care at 456 Broadway Boulevard but does not take appointments for this location. Both locations share a TIN and GNPI. Only the 123 Main Street location is needed.  
    • Example 2: If Dr. Smith also helps out, but does not take appointments at 789 Layton Ave, but this location has a different TIN/GNPI combo, the location would be needed but should not display in the directory.

 

The Provider Directory is audited for accuracy on a quarterly basis.  Audits are conducted via phone call to verify the following:

• The practitioner works out of the listed location.
• Appointments to see members can be scheduled for that location.
• The phone number is the correct number to call for an appointment. 

 

If you have questions about the information shared above, please reach out to your Provider Relations Representative. If you don’t know your representative, call 1-800-222-9831 or email WI_Provider_Relations@mhswi.com.