Provider Directory Updates

110.2.2 – Provider Directory Updates (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) MAOs are expected to update directory information any time they become aware of changes. All updates to the online provider directories are expected to be completed within 30 days of receiving information. Updates to hardcopy provider directories must be completed within 30 days, however, hardcopy directories that include separate updates via addenda are considered up-to-date. MAOs should contact their network/contracted providers on a quarterly basis to update the following information in provider directories: • Ability to accept new patients; • Street address; • Phone number; and • Any other changes that affect availability to patients. MAOs should contact providers using a method that is likely to achieve the highest response rate. It is not sufficient to determine that a group practice is accepting new patients. Outreach does not apply to entities such as hospitals. All providers listed in hard copy or online directories must have current contracts to participate in the MA plan network. Directories provided during the AEP for the upcoming plan year are expected to fairly represent the network for the upcoming plan year. Note: Employer/Union-only Group Waiver Plans (EGWP) may direct enrollees to their employer for information on the available providers. Employer/Union-only Group Waiver Plans (EGWP) must comply with the same requirements that are applicable to all MA and PDP plans regarding the provision of hard copy and online directories.