July 2021

Surprises in the No Surprises Act: New Requirements for Plans and Providers Regarding Provider Directory Information

In a co-authored article for the Health Care Compliance Association’s (HCCA) Compliance Today publication, Faegre Drinker Consulting Principal Mike Adelberg explores section 116 of the No Surprises Act, “Protecting patients and improving the accuracy of provider directory information,” which establishes a set of new requirements for health plans and providers that will be effective on January 1, 2022.

Adelberg describes how section 116 of the No Surprises Act takes on long-simmering problems regarding the accuracy of network provider information in health plan directories and related materials. He further addresses provider directory challenges, the role of providers, best practices and strategies for achieving compliance and enforcing section 116 compliance requirements.

In conclusion, Adelberg highlights five takeaways:

  1. To protect consumers and improve the accuracy of provider directories, the No Surprises Act puts important new requirements on health plans and providers.
  2. Inaccurate provider information can mislead consumers and fuel surprise bill scenarios.
  3. The No Surprises Act requires health plans to establish processes for maintaining public databases of accurate provider information, including requiring network providers to supply accurate and timely information.
  4. While important federal regulations are forthcoming, the directory accuracy requirements of the No Surprises Act become effective on January 1, 2022.
  5. Health plans and providers have no choice but to examine their current processes and begin taking steps to prepare for the new requirements.

The full article is available for Compliance Today subscribers.

Copyright 2021 Compliance Today, a publication of the Health Care Compliance Association (HCCA).

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