Accurate provider directories are essential for members to use as a resource tool in making informed health care decisions and for receiving timely access to care.
The Consolidated Appropriations Act (CAA), 2021, effective January 1, 2022, requires health plans to establish a process to verify and update provider directory information at least every 90 days. Providers are required to have in place processes to ensure the timely provision of provider directory information to support the health plan’s compliance with CAA requirements. Having accurate provider directory information is also a requirement for compliance with the Centers for Medicare & Medicaid Services (CMS), the Affordable Care Act (ACA) and your agreement as a network provider for Regence patients.
Note: Providers whose contract status has lapsed more than 30 days will be required to resubmit an initial credentialing application. Not having an active practice location is considered a lapse.
We require the following:
- Providers must continue to review to verify accuracy and submit all updated information about their practice at least every 90 days. In compliance with the CAA, we have defined our policy to require provider verifications every 90 days.
- Providers must notify us promptly of changes to directory information. Validate your practice information today by following the steps below.
- All participating providers who are eligible to display in directories based on their specialty and current credentialing status will be displayed in our provider directories.
- All participating providers are required to comply with our policies and procedures related to furnishing information necessary to ensure provider directories are up-to-date, accurate and complete pursuant to federal and state law, including 45 C.F.R. 156.230(b). This information includes, but is not limited to, accepting new patients, provider practice location, contact information, specialty, medical group and other institutional affiliations.
- Providers must review, update and return roster validation requests from us.
- Failing to verify directory information is grounds for removal from our provider directory and/or termination of the provider’s agreement with us.
A provider is removed from our directory in the following scenarios until such time that the provider properly verifies or updates their directory information:
- Research results in inability to verify a provider’s directory information based on the most recent information from the provider, internet research, claims data submitted, an out-of-service phone number or failure to reply to voice messages or email;
- Research based on member feedback of invalid contact information that we are unable to verify or update; or
- When notified of a provider’s retirement, move out of area or death.
Follow these steps to verify and attest to the information about your practice and the networks you participate in at least every 90 days:
- Visit Find a doctor from any page on our website.
- Type the provider's last name, first name in the search field.
- Verify demographic information for each location.
- Verify whether the provider is accepting new patients or offering telehealth services at each location. If you are a behavioral health provider, please verify your areas of focus.
- Confirm that patients may make appointments to be seen at each location listed for that provider.
Select the link for Networks Accepted to verify which networks apply for each provider at each location. You may need to review multiple types of networks (medical, dental or Medicare).
If your information is correct, you do not need to do anything else at this time.
Complete the Electronic Contracting Registration form to:
- Register for electronic contracting
Update information for the individual designated with the authority to review and sign agreement documents on your behalf (your legal signatory)
We routinely audit the information in our provider database. Please be sure to respond to any requests from us for validation of your provider directory information. Even if the information we have is accurate, we need your response for confirmation.
Regulatory agencies, CMS and other entities may also audit our provider directory accuracy by contacting your office. Please designate a staff member to respond to these requests. It is critical that the responder is informed and aware of what networks you participate in, and can confirm whether you are accepting new patients or not.
CMS can fine insurers up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per member for errors in plans sold on federally run insurance exchanges.