IL| The Illinois Department of Insurance (DOI) issued updated guidance on provider directory self-audits for network plans under the Network Adequacy and Transparency Act (NATA), effective January 1, 2025, following the enactment of the Healthcare Protection Act. Issuers must conduct self-audits every 90 days, submit unredacted reports and summaries to the DOI, and ensure directories are accurate and accessible both online and in print. Non-compliance may result in civil penalties of up to $25,000 per violation.
Key Points:
- Audit Requirements: Issuers must audit provider directories quarterly, submit reports by specific deadlines, and use the updated Audit Summary Template.
- Directory Accessibility: Online directories must be publicly accessible without login requirements, updated monthly or within 2 business days of changes, while printed copies must align with online data.
- Penalties: Failure to update directories on time results in fines of $5,000/month, with additional penalties of up to $25,000 for knowingly including incorrect providers.
