1/5/2022
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Posted by Provider Relations
The No Surprises Act (part of the Consolidated Appropriations Act, 2021) goes into effect January 1, 2022, and includes new requirements regarding provider directory information. These requirements apply to commercial individual market issuers and group health plans. Further rulemaking is forthcoming. In the meantime, Fidelis Care is using a good faith, reasonable interpretation of the law per guidance released in August 2021.
Provider Expectations
Starting January 1, 2022, each health care provider/facility must have business processes in place to ensure timely provision of provider directory information. In addition to existing requirements, providers must submit provider directory information to a plan or issuer when either of the following conditions is met:
- When the provider or facility terminates a network agreement; or
- When there are material changes to the content of provider directory information.
Compliance with these requirements ensures that provider listings remain visible to members in provider directories. Providers should work internally to confirm that the directory information they verify is correct and compliant with industry standards.
Health Plan Actions
In support of the No Surprises Act (section 116), Fidelis Care will:
- Capture providers’ digital contact information (i.e., web addresses or email addresses) for display in online and print directories.
If you have any questions, please call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547) or your Provider Relations Specialist.