N.J. Admin. Code § 11:24C-4.5

Current through Register Vol. 56, No. 8, April 15, 2024

Section 11:24C-4.5 - Content and availability of provider network directories

(a) Carriers shall maintain accurate and current information on all providers, and make that information available to members and prospective members through network directories, as described in this section.

(b) Directories shall include, at a minimum, the following information on all participating providers: name, gender, office locations, phone numbers, professional designation, specialty, acceptance of new patients, practice limitations, and languages spoken other than English.

(c) Directories shall contain a listing of the carrier's in-network hospital outpatient facilities by the types of services the facilities provide. Where applicable, directories shall also prominently display a statement advising members that not all outpatient service providers located at in-network hospitals are in-network providers, and urging members to confirm whether an outpatient service provider is or is not a member of the network before obtaining services from such provider.

(d) A carrier's electronic directory shall include functions designed to facilitate the ability of members to customize their search for providers. Search functions shall include, but not be limited to, specialty and geographic area.

(e) Upon request, carriers shall provide their current printed directory to members and prospective members of the health benefits plans offered by the carrier. The requirement to supply printed directories upon request may be complied with by printing and mailing the most current version of the on-line directory applicable to a particular member's plan in lieu of periodic publication and stocking of hard copy directories. The carrier shall mail a copy of the printed directory to a member or prospective member within five business days of the request measured from the date of the carrier's receipt of the request.

(f) If a carrier publishes a hard copy of the directory, the information shall accurately reflect the content of the carrier's electronic directory as of the date the printed directory was submitted for publication. The following information shall be included in or accompany the printed directory:

1. The date of publication of the printed directory;

2. A statement that the directory is accurate as of the date on which the printed directory was submitted for publication;

3. A statement that more current directory information is available on the carrier's electronic directory available on the carrier's website;

4. The anticipated date on which the next printed edition will be published; and

5. The carrier's website address where the electronic directory can be accessed.

(g) Carriers shall maintain a history of their electronic directories for three years. This requirement may be met by establishing a capability of reconstructing a directory as of any date within the prior three years.

(h) Carriers publishing hard copy directories shall retain as business records copies of each version of its printed provider directory for at least three years from the publication date.

N.J. Admin. Code § 11:24C-4.5