February 15, 2022
No Surprises Act - Provider Directory Update
On January 1, 2022, Section 116 of the Federal Consolidation Appropriations Act, which addresses provider directory accuracy, became effective. The Act regulates the responsibility of both payers and providers regarding provider information that appears in payer provider directories. Referred to as the No Surprises Act (NSA), the Act requires the following as it applies to provider directories:
Health Partners Plans (HPP) is required to:
- Verify and update the provider directory information every 90 days, at a minimum.
- Implement a process to remove providers from directories if the provider is not compliant with responding to HPP’s attempts to verify provider data.
Providers are required to submit data changes to HPP:
- When providers terminate a network agreement.
- In response to the quarterly Provider Data Validation process.
- Any time there are changes to the content of provider directory information.
Current regulations (CMS and DHS) are still in effect and contractual obligations to notify HPP of providers’ changes still apply.
Each quarter, HPP distributes a Provider Data Validation Form to providers to verify their information. Providers are required to review the form, make any needed changes to the data on the form, sign and date the form, and return it to HPP. If there are no changes to the data, the provider is still required to sign and date the form and return it to HPP. Providers who do not respond to each quarterly validation process are at risk of removal from the HPP directory due to non-compliance with the No Surprises Act.
If you have any questions, please contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.