ICS Staff | Nov 15, 2023 | 0
In-Network or Out-of-Network… Update Your Directory Info Today
Another obscure portion of the No Surprises Act (passed with the Consolidated Appropriations Act of 2021) includes a requirement for providers and insurers to update network directories. This provision was intended to protect patients from “surprise” undiscounted fees charged by providers who were incorrectly listed in directories as in-network when the providers were no longer participating.
In fact, under the new law, CMS says that providers are required to refund patients “if the [patient] has inadvertently received out-of-network care due to inaccurate provider directory information.” In other words, providers will be limited to the discounted in-network reimbursement amount if they have not taken the required steps to make sure they are no longer listed in the in-network directory. Additionally, insurers can remove a provider from their directory if the provider does not supply updated information.
As with the Good Faith Estimate law, this portion of the No Surprises Act DOES apply to chiropractic physicians. In fact, CMS states, “The No Surprises Act provider directory requirements apply to health care providers and health care facilities. The statute doesn’t exempt any categories of providers or facilities from this requirement. [emphasis added]”
It is important to note that the directory change requirements will apply to ALL insurers and insurance networks.
In short, if you are or have ever been in-network with any insurer, we are urging our chiropractic physicians to update their directory information with each of those insurers.
According to HHS:
“At a minimum, providers and health care facilities must submit provider directory information to a plan or issuer:
- When the provider or health care facility begins a network agreement with a plan or issuer with respect to certain coverage;
- When the provider or health care facility terminates a network agreement with a plan or issuer with respect to certain coverage;
- When there are material changes to the content of provider directory information of the provider or health care facility;
- At any other time (including upon the request of plan or issuer) determined appropriate by
- the provider, health care facility, or the Secretary of Health and Human Services (HHS).”
Follow the Requirements and Shift Financial Responsibility to Insurers
It is very important to note that CMS clearly indicates that “under the No Surprises Act, the [provider] is permitted to require in the terms of a contract or contract termination that a plan or issuer remove the provider’s name from the directory at the time of termination of contract. Additionally, the [provider] is contractually permitted to require that the plan or issuer bear financial responsibility for providing inaccurate network status information to an enrollee. [emphasis added]” This means that you can require that the insurer cover the patient cost differences when you provide the appropriate information and the insurer does not make the updates.
The ICS strongly recommends that you follow the requirements of each of your networks (most importantly, many require the changes to be made online except in the most limited circumstances). When it is NOT possible to file the update online or follow their other requirements for one reason or another, providers should send updates via US Mail with return receipt requested along with a clear explanation why the provider could not file the change online or meet the insurers’ other requirements.
BlueCross BlueShield of Illinois Announcement
BlueCross BlueShield of Illinois issued a notice that gives information on how to update their directory and clearly indicates that the requirement is for both their current in-network doctors and those that were previously in-network but are now out of network. The notice includes instructions on how to make the directory changes for the various types of information contained in the directories. Therefore, to comply with the No Surprises Act, even providers who terminated their participation in the past should follow the instructions to update this information.