Mass. Gen. Laws ch. 176O, sec. 28 — MA Code / Part I / Title XXII / Chapter 176O / Section 28
Provider directories; contents; audits; print copies; customer service contact information; accommodations; accuracy; updates
Status: in_force

Section 28. (a) A carrier shall ensure the accuracy of the information concerning each provider listed in the carrier's provider directories for each network plan and shall review and update the entire provider directory for each network plan. A provider directory that is electronically available shall: (i) be in a searchable format; and (ii) make accessible to the general public the current health care providers for a network plan through a clearly identifiable link or tab without requiring the general public to create or access an account, enter a policy or contract number, provide other identifying information or demonstrate coverage or an interest in obtaining coverage with the network plan. Each electronic network plan provider directory shall be updated not less than monthly; provided, however, that an electronic network plan provider directory shall be updated more frequently than monthly if required by state or federal law or regulations promulgated by the commissioner, when informed of and upon confirmation by the plan of: (i) a contracting provider no longer accepting new patients for that network plan or an individual provider within a provider group no longer accepting new patients; (ii) a provider or provider group no longer being under contract for a particular network plan; (iii) a change of a provider's practice location or of other information required under this section; (iv) a provider's retirement or cessation of practice; or (v) any other information that affects the content or accuracy of the provider directory. (b) A provider directory shall not list or include information on a provider who is not currently under contract with the network plan. (c) A carrier shall periodically audit its provider directories for accuracy and retain documentation of the audit to be made available to the commissioner upon request. (d) A carrier shall provide a print copy of the provider directory information of a current provider directory upon the request of an insured or a prospective insured. The print copy of the requested provider directory information shall be provided to the requester by mail postmarked not later than 5 business days after the date of the request and may be limited to the geographic region in which the requester resides or works or intends to reside or work. (e) A carrier shall include in both the electronic and print formats of the provider directory a dedicated customer service email address and telephone number or electronic link that insureds, providers and the general public may use to notify the carrier of inaccurate provider directory information. This customer service information shall be disclosed prominently in the provider directory and on the carrier's website. The carrier shall investigate reports of inaccuracies within 30 days of the notice and modify the provider directory in accordance with any findings within 30 days of the findings. (f) A provider directory shall inform enrollees and potential enrollees that they are entitled to: (i) language interpreter services at no cost to the enrollee; and (ii) full and equal access to covered services that are required under the federal Americans with Disabilities Act of 1990 and Section 504 of the federal Rehabilitation Act of 1973. 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, including how to obtain interpretation and translation services. (g) A carrier shall include a disclosure in the print format of the provider directory that the information included in the provider directory is accurate as of the date of printing and that an insured or prospective insured may consult the carrier's electronic provider directory on its website or call a specified customer service telephone number to obtain the most current provider directory information. (h) A carrier shall update the print copies of the carrier's provider directory not less than annually; provided, however, that the carrier shall update the print provider directories more frequently than annually if required by federal law; and provided further, that the division may promulgate regulations requiring that the print provider directories be updated more frequently than annually. (i) The division shall promulgate regulations to implement this section.

Section 28. (a) A carrier shall ensure the accuracy of the information concerning each provider listed in the carrier's provider directories for each network plan and shall review and update the entire provider directory for each network plan. A provider directory that is electronically available shall: (i) be in a searchable format; and (ii) make accessible to the general public the current health care providers for a network plan through a clearly identifiable link or tab without requiring the general public to create or access an account, enter a policy or contract number, provide other identifying information or demonstrate coverage or an interest in obtaining coverage with the network plan. Each electronic network plan provider directory shall be updated not less than monthly; provided, however, that an electronic network plan provider directory shall be updated more frequently than monthly if required by state or federal law or regulations promulgated by the commissioner, when informed of and upon confirmation by the plan of:

(i) a contracting provider no longer accepting new patients for that network plan or an individual provider within a provider group no longer accepting new patients;

(ii) a provider or provider group no longer being under contract for a particular network plan;

(iii) a change of a provider's practice location or of other information required under this section;

(iv) a provider's retirement or cessation of practice; or

(v) any other information that affects the content or accuracy of the provider directory.

(b) A provider directory shall not list or include information on a provider who is not currently under contract with the network plan.

(c) A carrier shall periodically audit its provider directories for accuracy and retain documentation of the audit to be made available to the commissioner upon request.

(d) A carrier shall provide a print copy of the provider directory information of a current provider directory upon the request of an insured or a prospective insured. The print copy of the requested provider directory information shall be provided to the requester by mail postmarked not later than 5 business days after the date of the request and may be limited to the geographic region in which the requester resides or works or intends to reside or work.

(e) A carrier shall include in both the electronic and print formats of the provider directory a dedicated customer service email address and telephone number or electronic link that insureds, providers and the general public may use to notify the carrier of inaccurate provider directory information. This customer service information shall be disclosed prominently in the provider directory and on the carrier's website. The carrier shall investigate reports of inaccuracies within 30 days of the notice and modify the provider directory in accordance with any findings within 30 days of the findings.

(f) A provider directory shall inform enrollees and potential enrollees that they are entitled to: (i) language interpreter services at no cost to the enrollee; and (ii) full and equal access to covered services that are required under the federal Americans with Disabilities Act of 1990 and Section 504 of the federal Rehabilitation Act of 1973. 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, including how to obtain interpretation and translation services.

(g) A carrier shall include a disclosure in the print format of the provider directory that the information included in the provider directory is accurate as of the date of printing and that an insured or prospective insured may consult the carrier's electronic provider directory on its website or call a specified customer service telephone number to obtain the most current provider directory information.

(h) A carrier shall update the print copies of the carrier's provider directory not less than annually; provided, however, that the carrier shall update the print provider directories more frequently than annually if required by federal law; and provided further, that the division may promulgate regulations requiring that the print provider directories be updated more frequently than annually.

(i) The division shall promulgate regulations to implement this section.