New law requires accurate dental plan provider directories

A law created by Senate Bill 137 goes into effect on July 1 and requires all health plans to maintain accurate provider directories. This law requires dentists contracted with dental plans to respond to a plan's request for accurate directory information within 30 days or face payment delays, reimbursement reductions or, ultimately, termination of their participating provider agreement.

As the push toward increased transparency and accountability increases throughout the health care industry, health plans are under increasing pressure to steer enrollees toward contracted providers when seeking treatment to minimize patient out-of-pocket costs. The out-of-pocket difference can be significant to patients when they seek treatment from a provider, only to discover that the dentist listed in the plan directory is no longer contracted with their plan. This law was created to provide patients with more accurate and complete information as to which dentists are contracted with their dental plans and whether those dentists are accepting new patients.

SB 137 places extensive requirements on the dental plans in terms of compliance and penalties. The provider outreach efforts and the technology systems needed to meet directory compliance are both cumbersome and expensive. The plans are expected to modify their current online directories in order to be in compliance by July 1, and then change the directory format again once the standard format is developed and approved later this year by regulators.

For dentists participating as a contracted provider with multiple plans, it is vital that a system is established within the dental practice to ensure dental plan communications and outreach efforts are reviewed and responded to in a timely manner. Recommendations may include a separate email address for tracking plan communications or designating someone in the practice to be responsible for monitoring and responding to dental plan requests.

Failing to respond to the dental plan within 30 days of a request for verification of dental practice information could result in plan reimbursement disruption and provider participation. Additionally, dentists must notify the dental plan within five business days when there are changes in the dentist's capacity to accept new patients/plan enrollees.

CDA is actively engaged with the dental plans and regulators as they navigate SB 137 compliance and will provide more information to members as soon as it becomes available. For more information, please contact CDA Public Policy at 916.554.4984.

Learn about new provider directory law at CDA Presents
For more specifics regarding this new law, CDA members are encouraged to attend a CDA Presents presentation on SB 137 compliance at The Spot educational theatre in Anaheim at 10 a.m., Saturday, May 14. The presentation titled "Prevent Payment Penalties Under New Provider Directory Law," will provide an overview of the new provider directory law and its implications to consumers, dentists and dental plans.

Related Items

Beginning July 1, a new law will take effect requiring dental plans to comply with uniform standards and provide timely updates (practice address, license number, etc.) to their provider directories. The intent of the new law, SB 137, is to provide patients with more accurate and complete information as to which providers are participating in the plan's provider network.