§431:26-105 Provider directories. (a) A health carrier shall post electronically a current and accurate provider directory for each of the carrier's network plans with the information and search functions described in paragraphs (3) and (4) and:
(1) The health carrier shall ensure that the general public is able to view all current providers for a plan through an identifiable link or tab and without creating or accessing an account or entering a policy or contract number;
(2) The health carrier shall update each network plan provider directory at least monthly and shall periodically audit a reasonable sample size of its provider directories for accuracy and retain documentation of such an audit to be made available to the commissioner upon request;
(3) For each network plan, the health carrier shall make available the following information in a searchable format:
(A) For health care professionals:
(i) Name;
(ii) Gender;
(iii) Participating office locations;
(iv) Specialty, if applicable;
(v) Medical group affiliations, if applicable;
(vi) Facility affiliations, if applicable;
(vii) Participating facility affiliations, if applicable;
(viii) Languages spoken other than English, if applicable; and
(ix) Whether accepting new patients;
(B) For hospitals:
(i) Hospital name;
(ii) Hospital type, such as acute, rehabilitation, children's, or cancer;
(iii) Participating hospital location; and
(iv) Hospital accreditation status; and
(C) For facilities, other than hospitals, by type:
(i) Facility name;
(ii) Facility type;
(iii) Type of services performed; and
(iv) Participating facility locations; and
(4) In addition to the information in paragraph (3), a health carrier shall make available the following information for each network plan:
(A) For health care professionals:
(i) Contact information;
(ii) Board certifications; and
(iii) Languages spoken other than English by clinical staff, if applicable; and
(B) For hospitals and facilities other than hospitals: telephone number.
(b) Upon the request of a covered person or prospective covered person, a health carrier shall provide a print copy of a current provider directory or of the requested directory information as follows:
(1) The following provider directory information for the applicable network plan shall be included:
(A) For health care professionals:
(i) Contact information;
(ii) Participating office locations;
(iii) Specialty, if applicable;
(iv) Languages spoken other than English, if applicable; and
(v) Whether accepting new patients;
(B) For hospitals:
(i) Hospital name;
(ii) Hospital type, such as acute, rehabilitation, children's, or cancer; and
(iii) Participating hospital location and telephone number; and
(C) For facilities, other than hospitals, by type:
(i) Facility name;
(ii) Facility type;
(iii) Types of services performed; and
(iv) Participating facility locations and telephone number; and
(2) The health carrier shall include a disclosure in the provider directory that the information in paragraph (1) included 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 on its website or call customer service to obtain current directory information.
(c) For electronic and print provider directories, a health carrier shall indicate the following information:
(1) For each network plan:
(A) A description of the criteria the carrier has used to build the carrier's provider network;
(B) If applicable, a description of the criteria the carrier has used to tier providers;
(C) If applicable, the method by which the carrier designates the different provider tiers or levels in the network and identifies, for each specific provider, hospital, or other type of facility in the network, the tier in which each is placed, such as by name, symbols, or grouping, so that a covered person or prospective covered person may identify the provider tier; and
(D) If applicable, that authorization or referral may be required to access some providers;
(2) The provider directory applicable to a network plan, such as inclusion of the specific name of the network plan as marketed and issued in this State; and
(3) A customer service electronic mail 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.
(d) For the information required by subsections (a)(3), (a)(4), and (b)(1) in a provider directory pertaining to a health care professional, hospital, or facility other than a hospital, the health carrier shall make available through electronic and print provider directories the source of the information and any limitations, if applicable.
(e) The electronic and print provider directories shall accommodate the communication needs of individuals with disabilities and include a link to or information regarding available assistance for persons with limited English proficiency. [L 2017, c 191, pt of §1]