CALIFORNIA: New Provider Directory Accuracy Law (SB 137) requires plans to ensure that physician directories are accurate and up-to-date AND Removes the Doctor if No Claim(s) Filed After 3 Mos.

The new requirements underscore the importance of ensuring that practice demographic information, including whether or not the practice is accepting new patients, is up-to-date with contracted payers and any changes to practice demographics are communicated to the plan/insurer in a timely manner. (For more specifics about the provider requirements under SB 137, click here.)

By Physician News Network, LA County News

APRIL 11, 2016 – As consumers increasingly rely on provider directories to make decisions about their health coverage and where they receive care, America’s Health Insurance Plans (AHIP) is launching a pilot program to identify solutions for improving the accuracy and efficiency of data reporting with provider partners, the organization recently announced.

AHIP will work with BetterDoctor and Availity, two leading healthcare information and technology firms that focus on provider directory outreach and data updates, to launch the pilot project starting April 2016 in California, Indiana and Florida. Currently, 12 AHIP member plans, including eight in California, are participating in the effort, including:

      • Anthem (California & Indiana)
      • AvMed (Florida)
      • Blue Shield of California (California)
      • Cigna (Florida)
      • Florida Blue (Florida)
      • Health Net (California)
      • Humana (California, Indiana & Florida)
      • L.A. Care Health Plan (California)
      • Molina Healthcare of California (California)
      • SCAN Health Plan (California)
      • WellCare (Florida)
      • Western Health Advantage (California)

The California Medical Association will be hosting a webinar on the topic with AHIP and its California vendor, BetterDoctor, on April 27. The webinar will cover an overview of the pilot program and the requirements of the new law SB 137, including its effect on physician practices, as well as what to expect in terms of outreach and the information requested by the vendor. To register, click here.

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The pilot program will run from April to September, and more than 100,000 providers are expected to participate. The efforts come as new regulations can mean costly fines if insurers fail to keep accurate, up-to-date information on the physicians who are in their health plans.

The first step will be the most challenging, connecting to 75,000 of California’s 90,000 physicians by phone or fax or email. It’s important that practices respond in a timely manner to the verification requests, as the new law not only requires payers to maintain accurate and current directories, but it also requires physicians to do their part in keeping the information up-to-date. Failure of practices to comply with the new requirements may result in payment delays, removal from directories and even contract termination.

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In a statement from AHIP, the company said, health plans’ provider directories are key tools for individuals and families. Consumers who choose in-network providers are protected from unexpected medical bills including balance billing. However, one of the persistent challenges with data reporting and maintenance of provider directories is confirming and updating provider information in real time.

The pilot is designed to facilitate one primary point of contact for providers when updating or reporting changes to their practice information. Providers may be contacted by phone, email or fax with instructions on how to update their information. BetterDoctor and Availity will then share data changes with the participating health plans to update their online and hard-copy directories

The pilot will also help to ensure health plan and provider compliance with SB 137 requirements, which take effect July 1, 2016. The new law requires plans and insurers to comply with uniform standards and provide timely updates to their provider directories. The law includes multiple components aimed at providing patients with more accurate and complete information so they can identify which providers are in their payers’ networks.

The new requirements underscore the importance of ensuring that practice demographic information, including whether or not the practice is accepting new patients, is up-to-date with contracted payers and any changes to practice demographics are communicated to the plan/insurer in a timely manner. (For more specifics about the provider requirements under SB 137, click here.)

The pilot program will also help to alleviate the administrative burden on practices by reducing the number of plans individually reaching out to providers to verify practice information.

After the six-month pilot is completed, AHIP will conduct an independent evaluation using feedback from providers, health plans and consumers, and will then develop best practices.

SOURCE: http://www.physiciansnewsnetwork.com/la_county/article_2c94b5ce-fec5-11e5-9e5b-774dae2d7add.html

 

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