No Surprises Act: Three Ways to Address New Provider Directory Requirements

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By Priya Sabharwal, Associate Vice President, HGS Healthcare

In recent years, the healthcare industry has increasingly been paying attention to the error rates in health plan directories. Undependable directories create poor member experience by impacting access to care. The Consolidated Appropriations Act COVID-19 relief bill, signed into law on December 27, 2020, requires health plans and healthcare providers to work in tandem, so that members are informed and protected. 

This law, under the No Surprises Act – an interim final rule that recently passed – mandates that health organizations ensure provider directories are current and accurate. Currently this Act targets an effective date of January 1, 2022, with health plans required to verify provider contract status and updates every 90 days. Health plans and organizations that do not comply face penalties and both member and provider abrasion.

As Provider Network Operations is increasingly at the fulcrum of both health plan operations and optimized consumer experience, here are a few ways healthcare organizations can efficiently and effectively address the new provider directory requirements of No Surprises:

Health plans need to update provider directories and respond quickly to consumers.

The No Surprises legislation requires health plans to update their database within 48 hours of receiving demographic change requests from a provider. This output can be either shared through an automated nightly batch run that updates the plan’s database directly or as an output file in any desired format. Additionally, health plans can look to dashboards to provide visibility and ensure compliance, as well as access to data that can help drive process refinement specific to the experiences. For example, noting a provider prefers phone outreach to reduce provider abrasion. These insights go a long way toward both No Surprises compliance and the enhanced Star ratings, as well as reduced provider abrasion that supports optimized experiences.

Regular verification of provider contract status and updates are required at least once every 90 days.

Another network management challenge is reaching out to providers without adding to their workload. Traditionally, most provider verification campaigns for updated directory information are run by fax or phone. While provider outreach can be supported via fax, phone, or email depending on what works best for a particular office, the ideal option is directing providers to an online pre-populated form. Providers can easily update their information without having to deal with pesky manual forms or spend more time over phone, and health plans receive updates quickly and efficiently.

Healthcare providers must communicate information more frequently to health plans to verify accurate directory information.

Today’s providers must respond to a constant flow of requests that taxes resources and adds to cost. Network management experts can provide tools via customized auto-reminders to the contact person at practices, alerting them that it is time to attest demographic information pertaining to their providers. 

All of these No Surprises mandates are on the horizon—along with the requisite additional oversight and compliance. On the bright side, today’s healthcare organizations can seize the moment and accelerate their drive toward a more B2C healthcare experience. And third-party experts have the required core solutions to get them there faster—with critical No Surprises compliance knowledge, as well as solutions to meet of the ever-raised bar of optimized provider experience, accurate provider data/directory, and more cost-effective processes. When accurate information is made available on consumer directories, millions of members are empowered to make the choices that are best for them and their families.