West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-100 - Health Benefit Plan Network Access And Adequacy › Section 114-100-7 - Provider Directories

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				Provider directories shall be maintained by a health carrier for each of its
				health benefit plans having a network plan. Sample screen shots of the
				carrier's electronic provider directory and a PDF sample of the carriers
				printed provider directory must both be filed in SERFF with the access plan
				filing.
7.2. Provider directories
				maintained by a health carrier shall meet all of the following requirements:
7.2.1. 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 W.Va.
				Code §
										33-55-4;
7.2.2. When
				making the directory available electronically, the health carrier shall ensure
				that the general public is able to view all of the current providers for a
				network through a clearly identifiable link or tab without requiring an
				individual to create or access an account or requiring the entry of a policy or
				contract number;
7.2.3. The health
				carrier shall include a disclosure in the directory of the date of the most
				recent update for electronic directories, or the date of printing for printed
				directories. This disclosure shall state that the information included in the
				directory is accurate, to the best of the carrier's knowledge, as of the date
				of updating/printing, and that covered persons or prospective covered persons
				should consult the carrier's electronic provider directory on its website, or
				call the carrier's customer service telephone number, to obtain current
				provider directory information;
7.2.4. A health carrier shall provide a print
				copy of the requested pertinent portion of the current provider directory to a
				covered person or a prospective covered person within five business days of the
				request;
7.2.5. A health carrier
				shall include, in both the electronic and print directory, the following
				general information for each of its provider networks:
7.2.5.a. A description of the criteria the
				health carrier has used to build its provider network;
7.2.5.b. A note that an authorization or
				referral may be required to access some providers;
7.2.5.c. A description of the criteria the
				health carrier has used to tier providers; and
7.2.5.d. A description of how the health
				carrier designates the different provider tiers or levels in the network and
				identifies (
e.g.
, by name, symbols or grouping) which tier or
				level the following are placed in:
7.2.5.d.1.
				Each specific provider;
7.2.5.d.2.
				Each specific hospital; and
7.2.5.d.3. Each specific other type of
				facility in the network;
7.2.6. A health carrier shall make it clear,
				in both its electronic and print directories, which provider directory applies
				to a particular health benefit plan, such as including the specific name of the
				health benefit plan as marketed and issued in West Virginia;
7.2.7. The health carrier shall include, in
				both its electronic and print directories, customer service contact information
				by electronic means such as email, text, social media, telephone number, and an
				electronic link that covered persons or the general public may use to notify
				the carrier of inaccurate provider directory information;
7.2.8. For the items of information required
				in a provider directory pursuant to W.Va. Code §
										33-55-4 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; and
7.2.9. 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.