What You Need To Know: "No Surprises Act" And Provider Directory Verification Requirements

Posted by MPOWERHealth on Aug 31, 2021 10:02:37 AM

As part of the "No Surprises Act", health plans must establish a provider directory verification process by January 1, 2022.


Government providers and some states currently have similar requirements, but the "No Surprises Act" will make a provider directory verification process mandatory for almost all plans, including fully-insured, self-funded, and government plans.

The health plans cannot comply without the providers help. They will be considering the following:

1. How are we currently verifying our provider data and how often?

2. How will we track the last verified date?

3. What information should we verify?

4. What will happen to providers whose information cannot be verified as current and accurate?

There have been suggestions that providers who do not comply could be dropped to the bottom of the online directory search or eliminated from it entirely.

While we don't know what will happen, we do know that the best tactic will be for each provider to keep his or her CAQH profile current by reviewing it and re-attesting that it is accurate no less than every 90 days. It ensures that you have done your part and that your information is correct for potential patients.

 MPOWERHealth is here to help. Get in touch with us today to find out how we can assist with your practice optimization needs, from payor relations to credentialing, alternative payment models to strategic planning and marketing to compliance.


Topics: Orthopaedics, Neurosurgery, Neurosurgical Care, Musculoskeletal Care, Spine Bundles, Healthcare Analytics, Orthopedics, Physical Medicine and Rehabilitation, Independent Physicians, Value-based care, Technology, Texas, Georgia, Florida, Ohio, Oklahoma, Louisiana, Arizona, Practice Management, Practice Optimization, Revenue Cycle Management, Neurosurgeon Practice Optimization, Credentialing, Orthopedic Practice Optimization, No Surprises Act