Don’t You (Forget About Me)—Recent Requirements for Provider Directories in an Era of Consumer-Directed Health Care

• April 08, 2022

• Jeff Wurzburg , Norton Rose Fulbright US LLP
• Brian E. Hoyt , BRG

The era of increased health care transparency and consumer-directed health care is upon us. In the dawn of this new era, and the complex regulatory environment for health plans and insurance issuers (Health Plans), provider directories remain an overlooked, yet critical, tool for consumers. With Health Plans facing many competing, overlapping, and complex new regulatory requirements, it is understandable why the implementation of the No Surprises Act provider directory requirements may have been overlooked. While provider directory requirements are nothing new for managed care plans in the commercial, Medicare, and Medicaid markets, the new requirements provide additional consumer protections and place obligations on providers to be responsible for timely responses to Health Plans. Health Plans must also comply with provider directory requirements stemming from the Centers for Medicare & Medicaid Services’ (CMS’) 2020 Interoperability final rule.[2] Further, Health Plans must meet additional requirements under the Transparency in Coverage final rule, many of which rely on the same underlying provider data as directories.[3]