New federal mandate requires your attention to practice data
Quarterly validation needed to remain in directories for impacted plans
As you may be aware, the Consolidated Appropriations Act of 2021 (“CAA,” which contains the “No Surprises” rules at 42 USC 300gg-115) became effective Jan. 1, 2022. The rules seek to protect members from excessive out-of-pocket costs (surprise billing), improve access to care and help ensure that information available to members in provider directories is updated and accurate.
The legislation is designed to serve the interests of members enrolled in commercial and employer health plans and group or individual health insurance coverage. Thus, as a Magellan in-network provider serving this substantial population, your participation in this federally mandated process is critical.
The new federal regulations align with our existing requests that you maintain and attest to your practice/organization information, including your provider roster, at least quarterly.
What's not changing
Magellan will continue to work with you to keep your directory information current. This means you will still get a quarterly reminder to validate your practice information on the provider website. Elements requiring verification include, but are not limited to:
- Practice specialty
- Telephone number
- Digital contact information.
What happens to your practice information, as it appears in the provider directory,
during this review, will depend on how often you validate your information.
To comply with the CAA legislation, we are required to verify and update our provider directory information for commercial and employer plan members quarterly.* What happens to your practice information, as it appears in the provider directory, during this review, will depend on how often you validate your information:
Not updating your information will restrict the ease with which members can contact and self-refer to you, so please work with us to regularly maintain and attest to your practice/organization information.
We appreciate your compliance and collaboration on this new federally mandated initiative.
*If you serve in one of the public sector programs that Magellan manages, such as District of Columbia Medicaid, Louisiana Coordinated System of Care, Pennsylvania HealthChoices, Virginia Medicaid, and Wyoming Care Management Entity, please note that the data validation requirements will differ. Your provider directory information for these enrollees is not impacted by this legislation. The same is true for employee assistance programs, commercial Medicare and Medicaid plans.