August 04, 2017
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
The California Medical Association (CMA) continues to receive inquiries from practices concerned about the validity of requests for payors to confirm physician demographic information. The requests are related to the new provider directory accuracy law that took effect on July 1, 2016 (SB 137).
Under the new law, physicians are required to respond to plan and insurer notifications regarding the accuracy of their provider directory information either by confirming the information is correct or by updating demographic information as appropriate. As with any request for protected information, practices should verify the identity of the requesting party and carefully scrutinize the validity of the request. It will be imperative that staff responsible for phones, email and faxes are aware of the requirements and are prepared for any inquiries. It is also important that practices respond in a timely manner and are accurate in the responses given.
Practices should also be aware that some payors may delegate the provider directory outreach efforts to a third party vendor. If a practice has questions about the validity of an information request, they should contact the payor directly to confirm.
Practices are encouraged to respond to the information requests, as the law also requires physicians do their part to keep their information up-to-date. Failure to do so may result in a delay in payment and removal from the provider directory. Additionally, a payor may terminate a contract with a provider for a pattern of repeated failure to update the required information in the directories.
For more information about physicians’ obligations under the new law, see CMA's resource, “What Physicians Need to Know to Avoid Penalties Under the New Provider Directory Accuracy Law," (members only) as well as CMA On-Call document #7163, "Provider Directories."
CMA On-Call documents are available free to members in CMA's online health law library at www.cmanet.org/cma-on-call. Nonmembers can purchase On-Call documents for $2 per page.
Contact: CMA's reimbursement help line, (888) 401-5911 or firstname.lastname@example.org.