06/29/2016

Provider directory law in effect Friday


Effective July 1, a new law requires dental plans to comply with uniform standards and provide timely updates — including changes in 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 regarding providers participating in the plan's provider network.

To evaluate the effect of this legislation, CDA has reached out to regulators, dental plans and dentists to gather information to help educate members through the CDA Update and e-newsletter about the history and implications of this requirement.

This month, CDA interviewed member dentist Charles D. Stewart, DMD, who is a part-time practicing dentist in Agoura Hills, Calif., and employed as the regional dental director, western territory for Aetna to provide perspective as a contracted provider and as a regional dental director for one of the nation's largest dental plans.

The Q-and-A with Stewart below offers insight on the legislation and what dentists need to do to ensure they are compliant.

What processes or plans have you implemented in your practice to ensure compliance with SB 137?
I have responded to all correspondence sent to me. Some of the correspondence required a signature to acknowledge the amended contract sent, while other plans have sent passive amendments. Most of the plans simply asked for me to verify the demographic information they have on my practice and to inform them if there are any changes. I have also acknowledged that I must inform plans if/when my office is not accepting new patients.

As a contracted, participating dentist for dental plans, is there anything onerous about SB 137?
The most onerous thing about SB137 is addressing the volume of mail sent by plans. All of the mail is different, as are the requirements for compliance from each plan. I find that it is important to address every piece of mail, otherwise the plan may delay payment to me, as well as drop me from their list of contracted providers. 

As the dental director of a dental plan, what challenges are plans encountering to comply with SB 137?
The plans are faced with the requirement of communicating with every provider in California (both PPO and DHMO), and then following up on the responses to this communication. SB137 requires communication with providers twice a year. The plan has developed a work plan to assure compliance and this work plan also requires a double-digit number of additional full-time employees to adequately comply with the requirements of SB137.

What hurdles do you anticipate for network dentists to comply with the law?
One of the hurdles we have is that we, as a plan, know most of the mail and communication we send to a dental office is discarded and never read or responded to. Our proposed staffing level is to provide proactive follow-up to providers. Another of our hurdles is that many providers will not inform the plan when there are changes to their address, or the office closes to new patients or the office closes for business.

How has your dental plan elected to educate providers regarding SB 137 and updating their contact information and/or provider contracts?
Our plan is formulating letters to send to every provider in California. We are also formulating a process for follow-up to those letters.

How do you think more accurate provider directories will help dental plan enrollees/patients?
Aetna prides itself on updating and maintaining its provider directory. I do not expect that there would be much change for Aetna members. For those plans that are not as quick to update their directories, compliance with the new law will help to eliminate frustration and accurately record active providers and open offices.

For more information on SB 137, visit cda.org or contact CDA public policy at 916.554.4984.



Related Items

SB 137 requires dental plans to comply with uniform standards and provide timely updates for their provider directories and there are two numbers you need to know to ensure compliance with the new law that goes into effect July 1 — 30 and five. The goal of this legislation and resulting regulations is to provide patients with more accurate information to identify which dentists are participating with their dental plan.

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.

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