New regulations are designed to prevent surprise billing by out-of-network providers

As of January 3, 2022, you are out of compliance with your payers’ requirements to verify the information they publish about your organization in their provider directories. The No Surprises Act requires payers to institute processes that remove providers with unverified information from their provider directories.

When Congress passed the Consolidated Appropriations Act (CAA) last year, they included new provisions to protect patients from surprise billing. Now known as the No Surprises Act, two key aspects of the law that took effect Jan. 1, 2022, are:

• Pricing transparency – providing patients with advanced explanation of benefits and more-accurate cost estimates

• Provider directory accuracy – helping patients make informed decisions about the healthcare providers they                      choose and which insurance plans they select

To ensure your organization continues to be included in provider directories, make sure your payers have your most up-to-date information. 

New Federal Government regulations:

Provider directories now have to be validated every 90 days for all payors. Failure to do so, can result in terminated contracts and credentialing with possible fines appropriated by the payor if they are fined by the federal government. Then just try to obtain a contract without a gap in service. Unpaid claims are a sure thing in this situation.

Please let us know if you would like us to validate these directories on an ongoing basis.