SB-137 Requires Accurate Provider Directories in California

by Medversant Staff Writer

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Posted on October 14, 2015

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The California State Senate unanimously passed a bill 33 to 0. The bill (SB 137) will require health insurers to update their provider directories regularly with accurate data. Prior to purchasing a plan, consumers will be able to understand which doctors are in network and accepting new patients. The bill is scheduled to go into effect July 1, 2016.

California State Senator Edward Hernandez authored State Bill 137; the bill will require the Department of Insurance and the Department of Managed Health Care to create one standardized provider directory template for California insurers. The bill will also require health insurers to make their directory viewable online to the public. Health insurers will need to update directories at least weekly, with the following information:

• Practice location address
• Provider area of specialty
• Languages spoken (other than English) by provider and staff
• Whether a provider is accepting new patients
• Providers that participate in which networks and for which products
• Remove providers that are not presently under contract with the plan

Medversant has seen a major shift in healthcare reform enforcement and only anticipates that the regulations will become more stringent because data transparency is the new standard in healthcare. Medversant has helped large national healthcare organizations to small regional health plans to meet provider directory compliance.

http://www.leginfo.ca.gov.pdf
https://leginfo.legislature.ca.gov