Under the CMS Interoperability and Patient Access Final Rule (CMS-9115-F), payers (health insurers) have several requirements for providing a provider directory:

Accuracy and Completeness

• Up-to-Date Information: The provider directory must include accurate and current information about in-network providers. This includes provider names, contact details, specialties, and locations.
• Verification: Payers must regularly verify the information to ensure it is accurate and reflects any changes in provider status or network participation.

Accessibility

• Online Access: The directory must be available online through a secure and user-friendly portal or app, allowing patients and providers to easily search and access the information.
• Interoperability: The directory should be accessible through standardized APIs to support data exchange with other systems and applications, as required by the rule.

Update Frequency

• Regular Updates: The provider directory must be updated regularly to reflect changes in provider networks. Updates should be made promptly to ensure that the information remains current.

Data Elements

• Required Information: The directory must include key data elements such as provider names, addresses, phone numbers, specialties, and any affiliations with healthcare facilities. It should also indicate which providers are accepting new patients, if applicable.

Compliance with Standards

• Standardized Formats: The directory must comply with industry standards for data sharing and interoperability, including using standardized formats and terminologies to ensure consistency and compatibility.

Search Functionality

• User-Friendly Search: The directory should provide a search function that allows users to easily find providers based on various criteria, such as location, specialty, and provider type.

Accessibility for Individuals with Disabilities

• Accessibility Standards: The directory must meet accessibility standards to ensure that individuals with disabilities can use the portal or app effectively.

These requirements are aimed at improving the accuracy and accessibility of provider information, which helps patients find appropriate care and supports better coordination between healthcare providers.