Provider Directory Maintenance Form (PDMF)
The Holman Group is committed to maintaining accurate provider directory information to help members access care and to support compliance with applicable provider directory, network adequacy, and timely access requirements.
Participating providers are required to notify The Holman Group of demographic, practice, and provider directory changes as soon as possible and no later than five (5) business days following the effective date of the change.
Examples of Updates That Should Be Reported Include:
- Practice, mailing, payment, or remittance address changes
- Telephone, fax, email, or website updates
- Office hours or days of operation
- National Provider Identifier (NPI) updates
- Tax Identification Number (TIN) changes
- Practice or provider name changes
- Provider joining or leaving a practice or group
- Opening or closing a practice location
- Acceptance of new patients
- Telehealth availability
- Languages spoken
- Specialty services offered
- Areas of expertise and populations served
- Hospital affiliations or privileges
- Accessibility accommodations available at the practice
Submit Updates Online (Preferred Method)
Providers may submit demographic and provider directory updates electronically by completing the online Provider Directory Maintenance Form (PDMF).
The online form allows providers to securely submit updates directly to The Holman Group’s Provider Relations Department for review and processing.
Providers who prefer to submit a paper form may download, complete, and return the Provider Directory Maintenance Form (PDMF) available on the website.
Benefits of Online Submission:
- Faster processing of provider updates
- Immediate delivery to Provider Relations
- Reduced paperwork and administrative burden
- Ability to upload supporting documentation when required
- Confirmation that your request has been received
Before submitting the form, please ensure all applicable sections are completed and any required supporting documentation is included.
Supporting Documentation
Certain updates may require additional documentation, including:
- Tax Identification Number (TIN) changes – Current IRS Form W-9
- Practice or legal entity name changes – Current IRS Form W-9
- License updates – Current license or certification, if applicable
- EFT/ACH updates – ACH Enrollment Form, voided check, or bank verification letter, if applicable
Questions?
If you have questions regarding the Provider Directory Maintenance Form or provider record updates, please contact Provider Relations at 800-321-2843.