Jessica Roe May 9, 2022 3:12:07 PM 7 min read

Provider Credentialing and the No Surprises Act: Provider Directory Requirements

Have you been receiving more directory verifications than ever before?

The reason is the new state and federal requirements included in the No Surprises Act that went into effect as of January 1, 2022. The No Surprises Act details the actions providers must take to ensure that patients do not receive surprise medical bills. This includes ensuring that insurance provider directories are correct, which will eliminate the chance of a patient selecting a non-participating provider or facility.

The No Surprises Act instructs health plans to formulate a process in which they work with providers and facilities to verify their own directory information. The health plans are required to do this at least every 90 days. Some insurances have already been verifying this information on a regular basis, but many have not, leading to an increase in the number of overall requests.

Health plans are using a variety of verification processes, including:

  • CAQH
  • Availity
  • Lexis Nexus
  • Emails sent to provider offices or credentialing contacts
  • Phone calls to provider offices or credentialing contacts

It’s important to know that if a provider or facility does not respond to a health plan’s verification request, the health plan can suppress the provider or facility from their directory. If a change is submitted to the health plan, the health plan has two days to update their system.

Information that the health plans will verify includes:

  • Provider/Facility Name
  • Service Location Address and Telephone Number
  • Specialty
  • Digital Contact Information

By verifying this information with health plans, providers and facilities can help ensure that patients can successfully locate and contact them, while also avoiding treating patients on plans with which they are out of network – a major contributor of surprise bills.

Interested in learning more about the No Surprises Act and its impact on your healthcare business? Check out the additional resources below, or schedule a meeting with the MMG team for one-on-one support.

Additional Resources:

Jessica Roe is a Credentialing Manager at MMG and has worked with credentialing clients in 16 states across various specialties.