WHAT YOU NEED TO KNOW.
Why am I being asked to verify my information?
New rules require you to verify information about yourself and your practice with each health plan you contract with. We work with 16 different health plans, including all the plans participating in the Washington health benefits exhange.
Current Federal Requirements:
- Medicare Advantage Standards
- Exchange/Marketplace (Machine Readable Standards)
- Medicaid Managed Care
State Regulations (California):
- California’s Senate Bill 137
- California Department of Insurance (CDI)’s Network
Why is BetterDoctor reaching out to providers to validate their information?
BetterDoctor contacts providers on behalf of health plans to help fix provider directories so consumers can find the latest, most up to date information. This fax directs providers to an online portal where they can securely update their information. Read more
How often am I required to verify my information?
Under Medicare Advantage rules, health plans are required to reach out to providers quarterly. With the new No Surprises Act starting January 2022, providers will be required to attest every 90 days for all Commercial plans. Under CA SB-137, health plans are required to reach out to providers at least once every six months. Health plans have partnered with BetterDoctor to simplify the process with California and Indiana health plans. However, you should also expect other health plans that are not affiliated with our effort to reach out to you. Please respond to all verification requests from all vendors or health plans.
How will my information be used?
The data you verify will be securely shared with participating health plans to update provider directories.
What are the consequences of not complying with Senate Bill 137?
Failure to verify your information may result in any of the following corrective remedies: removal from health plan print or online directories, delay of payments, or, for a repeated pattern of non-responsiveness, termination of health plan participation agreements.
Why are accurate provider directories important to consumers and health plan enrollees?
Health plan enrollees need accurate information about which providers and facilities they can visit in-network. Consumers need accurate information about the providers and facilities that are in health plan provider networks when shopping for coverage.
Have more questions about provider directories?
Visit the California Medical Association or the California Primary Care Association to learn more about what these new provider directory regulations mean for you.
Still have questions?
We’re happy to help you with the validation process, guide you through provider data regulations or answer any of your questions. Please visit our Help Center to find more answers or to contact support.
JOIN BetterDoctor AT NO COST!
BetterDoctor partners with health plans, large groups and health systems to simplify provider directory updates. We are a secure source of timely, accurate, and attested provider data for 450,000 providers (and growing). Provider data updates are distributed to participating health plans to improve network listings for patients seeking medical services.
Join BetterDoctor at no cost to ensure your provider data is listed accurately and up to date in contracted network directories. Participating groups can use existing roster files to maintain and improve data within the exchange.
REGULATORS ARE ENCOURAGING ACTION TO IMPROVE PROVIDER DATA
Since 2016, the Centers for Medicare & Medicaid Services (CMS) has required health plans to communicate with network physicians quarterly to verify directory information. Over the last 3 years, CMS audits have indicated that approximately 50% of Medicare Advantage Organization (MAO) directory listings had at least one critical deficiency that could impede a patient’s access to care. 1
The No Surprises Act now completes the requirement for provider data verification processes across all health plans for lines of business, meaning that you will be required to attest to the validity of your provider directory data with your health plan every 90 days. By participating in the BetterDoctor Exchange, your organization can help to ensure compliance with the latest regulations.