New Regulations Issued Around Provider Directory Accuracy

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doctors smilingPublished on February 20, 2015, 42 CFR Section 422.111(b)(3)(i); 422.112 (a)(1) states that Medicare Advantage plans, Qualified Health Plans (QHP) and Stand-Alone Dental Plans (SADP) offered through the Federal exchange need to have up-to-date and accurate provider directories in order to demonstrate provider network adequacy. The goals of this new regulation include providing current and accurate information on in-network providers so consumers don’t mistakenly visit out-of-network providers or providers no longer in practice. Doing so can result in consumers being hit with higher out-of-network bills.

Learn more about the challenges of maintaining provider directories and the current market approach to the new regulations by downloading the article.

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