Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.2.3
Provider Directory Dissemination and Timing
110.2.3 – Provider Directory Dissemination and Timing
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
MAOs must make the provider directory available to all enrollees at the time of
enrollment, and at least annually thereafter by September 30.
MAOs have some flexibility in how they provide access to their provider directories.
MAOs must send all enrollees either the provider directory in hard copy, or a distinct
and separate notice (in hard copy) describing where enrollees can find the provider
directories online and how enrollees can request a hard copy. This notice must be a
stand-alone document (i.e., not bound with other materials) and may be included in the
same mailing envelope as the Annual Notice of Change/Evidence of Coverage
(ANOC/EOC).
To take advantage of this flexibility under §422.11 to provide a notice of on-line
availability instead of providing a hard copy, an MAO must incudes in the notice the
following to ensure that enrollees may access a hard copy:
• If the MAO will not allow requests for a hard copy by email: “If you need help
finding a network provider, please call [customer service phone #] or visit [URL]
to access our online [searchable, if applicable] directory. If you would like a
provider directory mailed to you, you may call the number above, or request one
at the website link provided above.”;
• If the MAO will allow requests for a hard copy by email: “If you need help
finding a network provider, please call [customer service phone #] or visit [URL]
to access our online [searchable, if applicable] directory. If you would like a
provider directory mailed to you, you may call the number above, request one at
the website link provided above, or email [MAO email address].”