N.J. Admin. Code § 11:24C-4.6
Current through Register Vol. 56, No. 24, December 18, 2024
Section 11:24C-4.6 - Standards for accuracy of provider directory information(a) Carriers shall implement a system for maintaining accurate and current information on all providers listed in a network directory.(b) Carriers shall ensure the information in the provider directory is based on the most recently submitted information from the provider or the Council for Affordable Quality Healthcare (CAQH).(c) Carriers shall update electronic directories within 20 days of the carrier's receipt of confirmation from a provider or CAQH that current information is inaccurate or has changed. When a carrier disputes a notice that information on a provider is inaccurate, the carrier shall, within 15 days of receipt of a notice from a provider or consumer asserting that the information is inaccurate, respond to the notice in writing and include in its response the reason(s) supporting its position that the challenged information is accurate.(d) Carriers shall confirm the participation of any provider who has not submitted a claim for a period of 12 months or otherwise communicated with the carrier in a manner evidencing the provider's intention to continue to participate in the carrier's network and for whom no change in provider status has been reported by CAQH. The process for confirming participation shall be as follows:1. The carrier shall contact the provider and request that the provider confirm his or her intention to continue to participate in the carrier's provider network. Based on the provider's response, the carrier shall update its directories as necessary.2. If the provider fails to respond to a communication by the carrier, the carrier shall mail a follow-up request to the provider by certified mail, return receipt requested. If the provider fails to respond to such request within 30 days, the carrier shall remove the provider from its network and update its directories as necessary.N.J. Admin. Code § 11:24C-4.6