This regulation sets requirements for updating provider directories. It also provides certain protections for members who receive services from non-participating providers due to inaccurate directories.
Provider directories will include a set list of provider information items, and providers will be responsible for reviewing their information every 90 days. If they do not review within 90 days, they will be removed from the directory.
Who it applies to: Fully insured group health plans, self-funded group health plans and individual policies. Does not include grandfathered plans.
Effective date: Plan years beginning on or after Jan. 1, 2022.
Action required: No member or employer group action is needed at this time. BCBSND will maintain and execute changes submitted by providers within 48 hours to review and approve changes to go live in the provider directory. Providers will need to review their entry for accuracy every 90 days.