California Senate Bill 137: Improving Provider Directory Accuracy

Date: 04/28/16

In 2015, the California State Senate passed and signed into law Senate Bill 137 as California Health and Safety Code §1367.27 and California Insurance Code §10133.15. Beginning July 1, 2016, all California health care service plans will be required to publish and maintain the integrity of their provider directories.  The bill requires directories to be updated weekly with the most current provider information and panel status. Our Network Operations Department will reach out to you as frequently as every six months in order to validate the accuracy of your provider information.

The Department of Managed Health Care (DMHC) understands that collaboration between Plan and Provider is a vital component to ensure the success in providing current and accurate provider information to members.  As such, DMHC has required all plans to impose specific provider requirements related to Senate Bill 137.  In order for California Health & Wellness to be compliant with this requirement, we will be amending the provider responsibilities portion of the Provider Manual to include language and responsibilities surrounding Senate Bill 137.  These responsibilities are applicable to all California Health & Wellness provider, irrespective of provider type, effective July 1, 2016:

1. Respond to Health Plan inquiries to validate the accuracy of your provider information.  (Please be advised that Senate Bill 137 allows the Plan, at its discretion, to impose the following penalties for non-compliance: removal from provider directory, delay of payment or reimbursement, or even termination of provider contract.
2. Notify California Health & Wellness Plan within five (5) business days when either of the following occur:
   

   a. The provider is not accepting new patients.

   b. The provider is currently accepting new patients, if the provider had previously not accepted new patients.

3. If a provider who is not accepting new patients is contacted by an enrollee or potential enrollee seeking to become a new patient, the provider shall direct the enrollee or potential enrollee to California Health & Wellness Plan for additional assistance in finding a provider and to the DMHC to report any inaccuracy with the Plan’s provider directories.

You may notify us of provider information or panel changes via phone at (877) 658-0305, via email at CAProvData@cahealthwellness.com, or via the Provider Secure Portal.  We have also created an online form that can be accessed through our website to validate or update information. We sincerely appreciate your attention to this matter and look forward to maintaining our partnership in best serving our members.