BULLETIN NO. 13-2023
| To: |
All Health Insurance Companies, HMOs, and Other Interested Parties |
| Re: |
New Legislative Changes Requiring Health Benefit Plan Directories (SB 442) |
| From: |
Glen Mulready, Insurance Commissioner |
| Date: |
October 24, 2023 |
Electronic Directory Requirements
Effective November 1, 2023, Senate Bill 442, codified at 36 O.S. § 6971, requires any insurer of a health benefit plan that is offered, issued, or renewed in this state to publish an electronic provider directory for each of its network plans.
Information listed in the directory for health care professionals must include the name, phone number, physical address, website address, and, if applicable, specialty.
Information listed in the directory for hospitals must include the name, hospital type, participating hospital location, customer service telephone number, and website address.
Information listed in the directory for other health care facilities must include the name, facility type, types of services performed, participating facility location(s), customer service telephone number, and website address.
Additional requirements for each electronic directory include, but are not limited to, the following:
- The directory must be updated every sixty (60) days.
- It must be published on an easily accessible website in a standardized, downloadable, and searchable format.
- The directory must be accessible to individuals with disabilities and individuals with limited English proficiency.
- The general public must be able to access the provider lists for each network plan through a clearly identifiable hyperlink(s) or website tab(s) without having to create any type of account, to login, or to submit a policy or contract number.
- For each network plan published, the directory shall include a plain and clear description of the criteria used to build the provider network, and, if applicable, a description of the criteria used to tier providers, designation of the different providers tiers or levels, and a notice that authorization or referral may be required to access some providers.
Auditing Requirements
Section 6971 also requires health benefit plans to implement a process to receive and investigate any reports from the general public that information in the directory is inaccurate. Each directory shall contain a clearly identifiable telephone number, email address, or webpage link to which an insured or the general public may report inaccurate directory information. Health benefit plans must investigate any reports received within two (2) calendar days and either verify the information is accurate or update it.
Each health benefit plan is required to annually audit its provider directories for accuracy through one of the following methods:
- A focused audit of the top four utilized specialties, which must include at least one specialty related to mental health, OR
- An audit of a reasonable sample size of providers, which must include behavioral health providers. The audit must include the sample size amount and explain the methodology used by the plan to determine the reasonableness of that sample size amount.
Documentation of the audits shall be retained and made available to the Insurance Commissioner upon request. Annual audit reports shall be filed with the Insurance Commissioner as described below under “Reporting Requirements.”
Plan Notification Requirements
If, within a twelve-month period, a provider has not submitted claims to a health benefit plan or otherwise communicated intent to continue participation in the plan, the insurer of the health benefit plan shall notify the provider that the provider will be removed from the network. Such notice shall be sent in accordance with the notice provisions in the contract between the plan and the provider, or, if no such terms, by either certified mail, return receipt requested, or electronic mail, read receipt requested. If the provider does not respond within thirty (30) days of the notice, the plan must remove the provider from its network and update the directory.
Reporting Requirements
By March 1, 2025, and by each March 1st thereafter, each insurer of a health benefit plan shall file with the Oklahoma Insurance Department an Annual Provider Directory Audit Report, which shall include at least the following information in accordance with 36 O.S. § 6971(H):
- Number of reports of inaccurate information received;
- Timeliness of the response to those reports from the plans;
- Actions taken; and
- Annual auditing reports.
The Annual Provider Directory Audit Report shall be filed electronically through OPTins in the format prescribed by the Commissioner and in accordance with any instructions posted on the OID website.
Regulated entities can direct inquiries regarding this bulletin to Nicole Nash, OID Deputy General Counsel, at Nicole.Nash@oid.ok.gov.
