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CAQH and Provider Directory Accuracy

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New legislation has placed a greater emphasis on provider directory accuracy. Please make sure the practice location information in the CAQH ProView profiles referenced below is up to date. Health plans are using CAQH ProView to collect provider directory information.

  • If the provider is now practicing at a new location, has a change to an existing location or is no longer practicing at a location, please have the provider log in to the ProView account and make those changes.
  • If details about the practice have not changed since the provider’s last attestation or confirmation, a ‘No Change’ indication must be made for each active practice location for the provider.

A full provider attestation is not needed for these types of updates. Confirmed practice location data (updates or a confirmation of “No Changes”) will be sent to health plans upon clicking the save button.

While CMS has previously focused on Medicare and Medicaid directories, the No Surprises Act is a federal law that extends directory accuracy requirements to commercial plans. The Act also recognizes that ensuring directories are accurate is a shared responsibility of both plans and providers. These regulations:

  • Require providers to
    • Maintain a database of provider directory information.
    • Launch a verification process to update provider directory information quarterly.
  • Require plans to
    • Implement a process to remove unverified providers quarterly.
    • Execute a process for updating provider directory information within two-days of receipt from the provider.
    • Implement a response protocol that ensures a provider’s network status request is responded to within one business day and communication is maintained for two-years.
    • Post balance billing protections.

For more information, click here.

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