SmartMD
Insurance Directory & Provider Credentialing Management.
Reduce risk. Save time. Spend less.
SmartMD provides providers, groups, and facilities the ability to efficiently manage provider credentials and sensitive documents within a DLT-secured, HIPAA-compliant vault, ensuring that your credentials remain current and that re-credentialing and contracted rate negotiations are completed punctually.
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Expert Support
Ensure Insurance Directory & CAQH Accuracy
New legislation has placed a greater emphasis on provider directory accuracy.
While CMS has previously focused on Medicare and Medicaid directories, the No Surprises Act is a federal law that extends directory accuracy requirements to commercial plans. The Act also recognizes that ensuring directories are accurate is a shared responsibility of both plans and providers. However, insurance networks place the burden on the provider.
Timely Updates
At Metro NeuroHealth, we understand the importance of promptly adhering to new regulations. Our dedicated team swiftly submits your necessary attestations, ensuring your compliance with the most current standards.
Inaccurate Provider Directory Information
The No Surprise Act (NSA) safeguards patients who obtain care from out-of-network providers as a result of misleading information in provider directories.
CAQH Profile Maintenance
Metro NeuroHealth credentialing experts are dedicated to maintaining the accuracy and reliability of your CAQH profile. They regularly update your credentials and attest to the information provided, ensuring that it remains current and reflects any changes that may occur. This meticulous attention to detail helps streamline processes and supports your professional reputation in the healthcare landscape.
Verification Process
Verifying the provider directory can often be a time-consuming and tedious task. Our SmartMD credentialing specialists efficiently manage provider insurance portals and directories, maintaining accuracy to guarantee your continued in-network status.
NSA Provider Obligations
Under the law, healthcare providers are obligated to furnish patients who lack specific types of healthcare coverage, or who are not utilizing certain coverage options, with an estimate of their anticipated costs for healthcare items and services prior to the provision of said items or services.
Enrolling in the SmartMD Program can facilitate your compliance with these requirements.
Insurance networks will eliminate providers from their network if provider directories and portals are not updated timely as required.
Unverified providers will be purged from directories every 90 days to uphold integrity.
Empowering Your Practice
Streamlined Insurance Management for Providers & Group Practices
New legislation emphasizes the importance of maintaining accurate provider directories. With the No Surprises Act, both providers and insurance plans share the responsibility of ensuring that directory information is up-to-date. This is crucial for protecting your in-network status and avoiding unexpected out-of-network charges.
Navigating the complexities of provider directory regulations can be challenging. Metro NeuroHealth is here to guide you through the process, ensuring your practice remains compliant and your patients have access to your services.
SmartMD Keeps Providers & Group Practices In-Network
New legislation has placed a greater emphasis on provider directory accuracy.
While CMS has previously focused on Medicare and Medicaid directories, the No Surprises Act is a federal law that extends directory accuracy requirements to commercial plans. The Act also recognizes that ensuring directories are accurate is a shared responsibility of both plans and providers. However, insurance networks place the burden on the provider.
These regulations require providers to:
- Ensure timely submission of provider directory information.
- Update plans if there is a change to network status.
- Provider directory and CAQH profile maintenance and timely attestations.
These regulations require plans to:
- Establish a process to verify provider directory information every 90 days.
- Make updates within two-days of receipt from the provider.
- Implement a process to remove unverified providers every 90 days.
PROTECT IN-NETWORK STATUS
AVOID BEING MOVED OUT OF NETWORK
When providers and groups fail to keep their portals, directories, and CAQH profiles updated, they risk being removed from the network. If you have any inquiries, we invite you to arrange a complimentary, no-obligation virtual consultation with an MNH Credentialing Specialist.
Streamlining Provider Data
Provider Directory Management
Accurate Listings
Ensuring provider directories, portals, and CAQH profiles are complete and accurate is essential for informed patient choices.
Collaborative Efforts
We are working with health plans and providers to enhance the quality of provider data management.
Ongoing Updates
Future Vision
Join us on our journey to create a provider insurance maintenance program to assist providers with their in-network status.
Untangling the Complexities of Provider Data Management
For health plans and providers, managing provider directories presents a significant challenge that is both costly and time-consuming.
On average, providers engage with 12 health plans, each of which may contact them quarterly to verify provider information.
$2.1 Billion Spent
Each year, an estimated $2.1 billion is spent nationally by plans and providers to maintain provider databases.
49% Inaccurate
49% of online provider directories for Medicare Advantage organizations had at least one inaccuracy.
Frequently Asked Questions
What are the new requirements for providers?
Providers must ensure timely submission of directory information, update plans on any changes to network status, and maintain their CAQH profiles with timely attestations.How often must plans verify information?
Insurance plans are required to verify provider directory information every 90 days and must make updates within two days of receiving new information from providers. However, insurance plans have pushed the directory maintenance responsibility onto the providers to maintain - this is where the SmartMD Program comes in. SmartMD does the work on behalf of the provider.
What happens if my information is not updated?
Failure to keep your portal and directory information current can lead to being moved out of network, which can significantly impact your practice and patient care.
How can I protect my in-network status?
Regularly update your provider directory information and ensure your CAQH profile is accurate to avoid being removed from the network.What support does Metro NeuroHealth offer?
Metro NeuroHealth provides comprehensive support for physicians, including insurance portal, directory, and CAQH compliance and assistance with insurance network contracting.
