Keeping provider directories up to date is challenging for all stakeholders involved – from providers, to provider groups and health plans. Read this FAQ to understand why BetterDoctor sends practices a fax directing them to verify their information online on behalf of health plans.
UPDATE (2018): We’re now working with health plans all over the country, not just in California but all the 50 states. If you are from the state of Washington, please check this press release about how we are helping patients in Washington to find the right doctor. If you are contracted with Humana, please reference this post by Humana.
Why am I being faxed to verify my information?
BetterDoctor faxes providers on behalf of health plans to help fix provider directories so consumers can find the latest, most up to date information. This fax directs providers to an online portal where they can securely update their information. Additionally, new rules require providers - doctors, practitioners, etc - to verify information about providers and their practice with each health plan he/she contracts with.
Who is BetterDoctor?
BetterDoctor helps health plans and providers get compliant with new provider directory regulations.
How does BetterDoctor’s provider data validation platform work?
- BetterDoctor takes health plan provider roster.
- Uses effective multimodal outreach methods to validate data from each provider.
- Validated data is then exported to health plans to update their provider directory.
In 2016, BetterDoctor ran an AHIP-sponsored pilot with nine health plans in California and Indiana. After the positive pilot outcomes, BetterDoctor is now expanding the validation work to national scale.
How often am I required to verify my information?
Under Medicare Advantage rules, health plans are required to reach out to providers quarterly. Under CA SB-137, health plans are required to reach out to providers at least once every six months. Health plans have partnered with BetterDoctor to simplify the process with California and Indiana health plans. However, you should also expect other health plans that are not affiliated with our effort to reach out to you. Please respond to all verification requests from all vendors or health plans.
How will providers’ verified information be used?
The data you verify will be securely shared with participating health plans to update provider directories.
The name on the fax is not a provider practicing at my location. What do I do with this information and form?
If you receive a fax and the provider is not at your location, it is important to let health plans know this information has changed. This is one of the key reasons why it is important to consistently verify provider directory information.
What are the consequences of not complying with Senate Bill 137?
Failure to verify your information may result in any of the following corrective remedies: removal from health plan print or online directories, delay of payments, or, for a repeated pattern of non-responsiveness, termination of health plan participation agreements.
Why are accurate provider directories important to consumers and health plan enrollees?
Health plan enrollees need accurate information about which providers and facilities they can visit in-network. Consumers need accurate information about the providers and facilities that are in health plan provider networks when shopping for coverage.
Have more questions about provider directories?
Still have questions?
We’re happy to help you validate your information, answer any questions about the new regulations, or help you through our validation process. Visit our Help Center or if you can’t find what you are looking for, email firstname.lastname@example.org and we’ll get back to you as soon as we can.