Provider directories
(a)(1)(A) A health carrier shall post electronically a current and accurate provider directory for each of its network plans with the information and search functions, as described in subsection (b) of this section.
(B) In making the directory available electronically, the carrier shall ensure that the general public is able to view all of the current providers for a plan through a clearly identifiable link or tab and without creating or accessing an account or entering a policy or contract number.
(2)(A) The health carrier shall update each network plan provider directory at least monthly.
(B) The health carrier shall periodically audit at least a reasonable sample size of its provider directories for accuracy, and retain documentation of such an audit to be made available to the commissioner upon request.
(3) A health carrier shall provide a print copy, or a print copy of the requested directory information of a current provider directory with the information described in subsection (b) of this section upon request of a covered person or a prospective covered person.
(4) For each network plan, a health carrier shall include in plain language, in both the electronic and print directory, the following general information:
(A) In plain language, a description of the criteria the carrier has used to build its provider network;
(B) If applicable, in plain language, a description of the criteria the carrier has used to tier providers;
(C) If applicable, in plain language, how the carrier designates the different provider tiers or levels in the network and identifies for each specific provider, hospital, or other type of facility in the network which tier each is placed, for example, by name, symbols, or grouping, in order for a covered person or a prospective covered person to be able to identify the provider tier; and
(D) If applicable, note that authorization or referral may be required to access some providers.
(5)(A) A health carrier shall make it clear for both its electronic and print directories what provider directory applies to which network plan, such as including the specific name of the network plan as marketed and issued in this state.
(B) The health carrier shall include in both its electronic and print directories a customer service email address and telephone number or electronic link that covered persons or the general public may use to notify the health carrier of inaccurate provider directory information.
(6) For the pieces of information required pursuant to subsections (b), (c), and (d) of this section in a provider directory pertaining to a health care professional, a hospital, or a facility other than a hospital, the health carrier shall make available through the directory the source of the information and any limitations, if applicable.
(7) A provider directory, whether in electronic or print format, shall accommodate the communication needs of individuals with disabilities, and include a link to or information regarding available assistance for persons with limited English proficiency.
(b) The health carrier shall make available through an electronic provider directory, for each network plan, the information under this subsection in a searchable format:
(1) For health care professionals:
(A) Name;
(B) Gender;
(C) Participating office location(s);
(D) Specialty, if applicable;
(E) Medical group affiliations, if applicable;
(F) Facility affiliations, if applicable;
(G) Participating facility affiliations, if applicable;
(H) Languages spoken other than English, if applicable; and
(I) Whether accepting new patients.
(2) For hospitals:
(A) Hospital name;
(B) Hospital type (i. e., acute, rehabilitation, children’s, cancer);
(C) Participating hospital location;
(D) Hospital accreditation status; and
(3) For facilities, other than hospitals, by type:
(A) Facility name;
(B) Facility type;
(C) Types of services performed; and
(D) Participating facility location(s).
(c) For the electronic provider directories, for each network plan, a health carrier shall make available the following information in addition to all of the information available under subsection (b) of this section:
(1) For health care professionals:
(A) Contact information;
(B) Board certification(s); and
(C) Languages spoken other than English by clinical staff, if applicable.
(2) For hospitals: Telephone number; and
(3) For facilities other than hospitals: Telephone number.
(d)(1) The health carrier shall make available in print, upon request, the following provider directory information for the applicable network plan:
(A) For health care professionals:
(i) Name;
(ii) Contact information;
(iii) Participating office location(s);
(iv) Specialty, if applicable;
(v) Languages spoken other than English, if applicable; and
(vi) Whether accepting new patients.
(B) For hospitals:
(i) Hospital name;
(ii) Hospital type, (i. e., acute, rehabilitation, children’s, cancer); and
(iii) Participating hospital location and telephone number; and
(C) For facilities, other than hospitals, by type:
(i) Facility name;
(ii) Facility type;
(iii) Types of services performed; and
(iv) Participating facility location(s) and telephone number.
(2) The health carrier shall include a disclosure in the directory that the information in subdivision (1) of this subsection, included in the directory, is accurate as of the date of printing, and that covered persons or prospective covered persons should consult the carrier’s electronic provider directory on its website to obtain current provider directory information.