Provider Directories

Nov 30, 2016

  1. Cenla Agent

    Cenla Agent Guru

    Likes Received:
    Shouldn't MA companies send provider directories to those who have enrolled? Due to the expense, one regional plan here doesn't send it out unless the member specifically asks for it. Do you find that this is common today? Sure many more people are online now compared to 10 years ago, but a high percentage are still computer illiterate. Sure, the book is out of date, but it is better than nothing. A competing plan will send the directory to people who merely call in for info during Pre-AEP or the AEP who aren't even members (yet.)

    (I'm sure I could check the MMG or some other CMS resource for this, but then what's this forum for? :goofy:)


    OK, I looked it up. From Chapter 4 of the Medicare Managed Care Manual:

    – Provider Directory Dissemination and Timing
    (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-

    MAOs must make the provider directory available to all enrollees at the time of
    enrollment, and at least annually thereafter by September 30.

    MAOs have some flexibility in how they provide access to their provider directories. MAOs must send all enrollees either the provider directory in hard copy, or a distinct and separate notice (in hard copy) describing where enrollees can find the provider directories online and how enrollees can request a hard copy. This notice must be a stand-alone document (i.e., not bound with other materials) and may be included in the same mailing envelope as the Annual Notice of Change/Evidence of Coverage (ANOC/EOC).

    To take advantage of this flexibility under §422.11 to provide a notice of on-
    line availability instead of providing a hard copy, an MAO must incudes in the notice the following to ensure that enrollees may access a hard copy:

    •If the MAO will not allow requests for a hard copy by email: “If you need help finding a network provider, please call [customer service phone #] or visit to access our online [searchable, ...rovided above, or email [MAO email address].”