New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter II - Administrative Rules and Regulations
Subchapter R - Health Maintenance Organizations
Part 98 - Health Maintenance Organizations
Subpart 98-5
Section 98-5.7 - Provider directory requirements
Current through Register Vol. 47, No. 12, March 26, 2025
(a) In addition to the provider directory requirements set forth in Public Health Law 4403 and 4408, when listing a behavioral health provider, the provider directory shall include:
(b) With respect to behavioral health providers, the provider directory that is posted on a publicly accessible area of the MCO's website shall be searchable and filterable by behavioral health services provided and conditions treated, level of care offered by a facility, languages spoken, affiliations with participating facilities certified or authorized by the Office of Mental Health or the Office of Addiction Services and Supports, and the city/town or zip code where the provider is located.
(c) In addition to the disclosure requirements set forth in Public Health Law 4408(1) (r), a MCO shall provide the enrollee or the enrollee's designee with a list of behavioral health providers available to treat a specific behavioral health condition within three business days of the request of the enrollee or the enrollee's designee.
(d) A MCO shall verify the accuracy of the information in the provider directory with behavioral health providers at least annually.
(e) A MCO shall review the claims activity of the first six months of the year by September 1 of that year and, for the second six months of the year by March 1 of the following year. If the MCO did not receive any claims from a participating provider of behavioral health services within those periods, the MCO shall confirm whether the provider is accepting new patients and the provider's participation status with the MCO.
(f) A MCO shall have a method available on a publicly accessible area of its website for enrollees, health care providers, and other persons to report errors in the provider directory information. Within 15 calendar days of receipt of reported errors, the MCO shall review the errors reported and ensure that the online provider directory information is accurate.