The California Medical Association (CMA) hosted a webinar last week to help doctors understand new compliance standards related to new provider directory laws.
BetterDoctor and America’s Health Insurance Plans (AHIP) answered questions from providers around the state about what to expect and what to be prepared for.
Listen to the full webinar at CMA’s website here and read the most commonly asked questions by doctors on the webinar below.
Q: How quickly will the provider directory be updated after information is validated?
Directory information will be updated within one week once changes have been verified as accurate. Once your information is received and confirmed, it will be included in our participating plan’s next provider directory weekly update.
Q: When do SB-137 and MA requirements go into effect?
SB 137 is effective July 1, 2016; Medicare Advantage requirements were effective on January 1, 2016.
Q: What is the purpose of the BetterData Alliance?
The BetterData Alliance’s goal is to simplify the process of updating provider information that must be maintained by health plans. By collaborating on getting and validating the data, the goal is to make the process more efficient for providers and health plans.
Q: If a doctor does not have changes to report, do they still have to answer to inquiries from BetterDoctor and other health plans?
Yes. Doctors must still confirm that their information has not changed to be compliant.
Q: How often should doctors expect to be contacted by BetterDoctor?
Doctors should expect to be contacted every quarter (90 days).
Q: As a practice manager, if I have over 50 providers, how can I be proactive about updating information about all 50 doctors that I work with?
Today, BetterDoctor’s outreach has the capacity to update up to 10 doctors over the phone. We will likely call you more than once to accommodate such a high number. However, in May 2016, we will be rolling out an online form in which you can proactively update the information of all 50 doctors that you work with. For larger medical groups, we are working on creating workflows to streamline their updates.
Q: Will the provider be penalized if the provider directory is not accurate even after having updated information with BetterDoctor?
If the provider has submitted changes in a timely fashion, the provider should not be penalized.
Q: If a provider/doctor leaves a practice, who should be notified? The payor or a provider practice manager?
As this may be a contractual matter, the provider should look to his/her contract with either the practice and/or the health plan. Whoever is ultimately responsible for owning the contract will be responsible for notifying the health plan that a doctor has left a practice.
Q: What phone numbers are required to be updated? Are marketing phone numbers acceptable?
Marketing or “vanity” phone numbers are not acceptable. Please supply BetterDoctor with the direct phone number where patients can reach the doctor.
Q: Will worker’s compensation doctors be listed by employers’ insurers?
These regulatory requirements do not affect worker’s compensation insurance and doctors that contract for workers compensation purposes are out of the scope of this project.
Q: How long do doctors have to respond to BetterDoctor?
BetterDoctor will make 3 attempts to reach out to doctors within 30 days. Doctors should respond as promptly as possible to ensure compliance and to avoid any penalties that may result. Should doctors not update their information in any given quarter, they risk delayed payments or being delisted from insurance provider directories.
Q: What if a provider ignores a call because they think is a scam? (How can doctors avoid fraud?)
Be careful with what is asked of you. We are updating demographic information about your practice such as provider name, phone number, and whether new patients are accepted. We do not request personal nor financial information from a provider like social security (SSN) #s or banking information. If you have doubts about the validity of requests, please do reach out to us at email@example.com. You will be able to find our direct support contact information on the fax campaigns, calls, and emails we send you.
Q: Can we contact BetterDoctor to provide the info or do we have to wait for BetterDoctor to reach out to us?
At this time, please wait until BetterDoctor reaches out to you. However, in the next month we intend to have self service channels by which doctors or practice staff can proactively update information.
Q: Where do IPA groups fall into this project? Do we also have to notify IPA groups of changes? The IPA groups are how providers (may) have contracts with health plans.
Today BetterDoctor is contacting individual providers directly. We are in talks to collaborate with medical groups and IPAs soon. It is important that you respond to any medical group or IPA inquiries as well. The group may be contractually obligated to update their medical group roster for contracting health plans as well.
Q: Are physicians required to respond to plan and insurer notifications regarding the accuracy of their provider directory information?
Yes. You must confirm that the information is correct or make the necessary updates. Failure to do so may result in delay in payment or possible removal from directory.
Q: What are the legal obligations on physicians to ensure that information is up-to-date?
California SB-137 mandates that providers notify associated payors (health plans) of any changes that may occur and also whether they accept new patients.
Alternatively, they also need to notify health plans if they do not accept new patients. If a doctor is not taking new patients but a patient found them on a provider directory, the doctor should direct the patient to the health plan or to a regulator to report the provider directory inaccuracy.