N.H. Admin. Code § Ins 2701.12

Current through Register No. 50, December 12, 2024

Section Ins 2701.12 - Provider Directories

(a) For each of its network plans, a health carrier shall electronically post and maintain a current and accurate provider directory in accordance with the following requirements and with the information and search functions described in (c) below:

(1) In 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 plan through a clearly identifiable link or tab, without creating or accessing an account or entering a policy or contract number;

(2) The health carrier shall update the provider directory for each network plan at least monthly;

(3) The health carrier shall periodically audit its provider directories for accuracy and retain documentation of such an audit to be made available to the commissioner upon request;

(4) For each network plan, a health carrier shall include, in an electronic directory, the following information stated in plain language:

a. A description of the criteria the carrier used to build its provider network;

b. If applicable, a description of the criteria the carrier used to tier providers;

c. If applicable, a description of the different provider tiers or levels in the network and, for each provider, hospital, or other type of facility in the network, identification of the tier in which each is placed; and

d. If applicable, disclosure that a specific provider is a network plan provider only for the specific services listed with the disclosure;

(5) A health carrier shall clearly indicate which provider directory applies to which network plan, including the specific name of the network plan as marketed and issued in this state;

(6) A health carrier shall include a customer service email address and telephone number or electronic link that covered persons or the general public may use to notify the health carrier of inaccurate provider directory information; and

(7) For the information required pursuant to (b), (c), and (d) below, a health carrier shall indicate in the directory the source of the information and any limitations, if applicable.

(b) For each network plan, the health carrier's electronic provider directory shall include the following information in a searchable format:

(1) For health care professionals:

a. Name;

b. Gender;

c. Participating office location(s);

d. Specialty, if applicable;

e. Medical group affiliations, if applicable;

f. Facility affiliations, if applicable;

g. Participating facility affiliations, if applicable;

h. Languages spoken other than English, if applicable; and

i. Whether accepting new patients;

(2) For hospitals:

a. Hospital name;

b. Hospital type, for example, acute, rehabilitation, children's, cancer, etc.;

c. Participating hospital location; and

d. Hospital accreditation status; and

(3) For facilities other than hospitals:

a. Facility name;

b. Facility type;

c. Types of services performed; and

d. Participating facility location(s).

(c) For each network plan, a health carrier shall make available in its electronic provider directory, the following information:

(1) For health care professionals:

a. Contact information;

b. Board certification(s); and

c. Languages spoken other than English by clinical staff, if applicable; and

(2) For hospitals and other facilities, a telephone number.

(d) Each directory shall include a date and a customer service telephone number and be accompanied by a disclosure by the health carrier that the information in the directory is accurate as of the date of printing and that covered persons or prospective covered persons should consult the carrier's electronic provider directory or call the customer service number to obtain current provider directory information.

N.H. Admin. Code § Ins 2701.12

Derived From Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12565, Effective 8/1/2018, Expires 8/1/2028.