Here are five takeaways:
1. The fines against insurers can total up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run insurance exchanges in 37 states. Payers found in violation of the CMS rules can also be banned from new enrollment and marketing.
2. New York and California are penalizing health plans that fail to provide accurate provider information to consumers.
3. To make it easier for providers to submit information on changes to their physician rosters, America’s Health Insurance Plans recently announced a new test model for updating provider directories.
4. Health plans are currently reaching out to update information perhaps only once a year, while Better Doctor, a vendor working with America’s Health Insurance Plans on the new test model, will reach out to providers at least four times a year.
5. Better Doctor will be contacting physicians in Indiana and California to update the provider directories for health plans in those states, and Availity, another vendor, will be doing the same in Florida.
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