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News & Views

No Surprises Act Rules Still Coming for Provider Directories

When the Centers for Medicare & Medicaid Services (CMS) released its first interim final rule for the No Surprises Act on July 1, 2021, it stated that the rule for provider directory validation requirements would not be released until sometime after January 2022.

Instead of listing an explicit rule, CMS asked health insurers and providers to “implement the requirements using a good faith, reasonable interpretation of the statute.”

As we head into the second quarter of 2022, insurers are still waiting for the final rule on maintaining accurate provider directories. However, many of them have used the time to put processes into place once the regulation is finalized. If you haven’t done so yet, it’s not too late to get started.

Provider Directories and No Surprises Act

The primary reason provider directory accuracy is included in the No Surprises Act is that patients rely on it to find healthcare providers that work in their insurance network. Additionally, insurers use provider directories to verify provider information, and providers use them to make referrals.

Patients and insurers alike want to feel confident that their bills will be paid as they expect to a provider listed in their network. When they find a provider listed in the directory they want the confidence they can reach them at the number listed, not hear a dial tone or a message stating that the number is no longer in service.

By mandating that provider directories stay up-to-date and accurate, CMS and HHS hope to relieve the frustration felt by patients, and employers who have received unexpected out-of-network bills from providers listed as in their networks.

How Have Insurers Been Managing Provider Directories in 2022?

So, what have health insurers been doing since last July to manage and monitor provider directories?

Unsurprisingly, there hasn’t been a uniform approach. However, three specific patterns have emerged.

1. Nothing because they already solved this problem

One group is taking the opposite approach of “watch and wait.” They’re ahead of the curve because they started incorporating new regulations for their commercial networks six years ago when the Medicare Advantage 90-day directory requirements were released.

2. Watch and wait

A small minority of insurers aren’t doing anything to ensure the accuracy of their provider directories. Instead, they’re taking a “wait and see” approach as they watch for the final rule. During this time, they trust providers to let them know when their information needs to be updated in the directory.

3. Start to build

Most health plans fall somewhere in between the above two options. They aren’t as ready as the second group, but they are actively working toward meeting whatever rule gets implemented instead of waiting to see what happens. These health insurers are assessing what it will take to validate their directory every 90 days, then using that information to build an automated process for updating records within two business days of receiving directory changes.

How to Get Ready for the Provider Directories Rule

We all know a rule for provider directories is coming. So, the best thing to do is prepare now so you’ll be ready when it finally hits.

Speak to our provider directory experts at HealthLink Dimensions today about your options. We can show you how to leverage cutting-edge technology to ensure a high-quality and cost-effective outcome that meets your compliance needs. In addition, you can see what you can learn from an analysis of your network when it is matched to over 500 public and proprietary data sources in HealthLink Dimensions’ national provider database.

Don’t fall behind the curve just because the provider directory rule hasn’t launched yet. Instead, get ahead and be ready when the regulations are released. Contact us today to get started.


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