Requirements under the No Surprises Act

"As of Jan. 1, 2022, Section 116 of the Federal Consolidation Appropriations Act, which addresses provider directory accuracy, became effective. It regulates the responsibility of both payers and providers regarding provider information that appears in payer provider directories. Referred to as the No Surprises Act (NSA), the Act requires the following as it applies to provider directories (paraphrased):

• Of Payers
  • That payers verify and update the provider directory information not less frequently than once every 90 days.
  • That payers establish a process to remove providers from directories if the payer is unable to verify the providers’ information.
• Of Providers
  • Providers shall submit provider directory information to a plan or issuers, at a minimum:
    • When providers terminate a network agreement.
    • When there are material changes to the content of provider directory information.
    • At any other time (including upon the request of such issuer or plan).

Additionally, current CMS/DHS/PID regulations are still in effect and contractual obligations to notify UPMC Health Plan of providers’ changes still apply. Incentive payment eligibility is contingent upon quarterly provider directory verification.

At the beginning of each quarter, LexisNexis will be reaching out through one or more of its three communication channels (phone, fax, or online) to verify that your provider information is accurate.

Alternatively, you can view your information by the following methods:

1. Searching the online directory for your name at upmchealthplan.com/find. You can make updates to your information at upmchealthplan.com/providers/change.html.
2. Searching Provider OnLine under ""Reports,"" ""Office Information Sheet."" Changes can be noted on the sheet and returned to the email address below. (If this section is not available to you, you can request access via your online administrator.)

If you have any questions, have trouble with your updates, or if your contact information has changed, contact your physician account executive or email providernetworkinquiries@upmc.edu."