90-Day Provider Directory Attestation: Key Carelon Compliance Requirements

Provider Directory Data: 90-Day Attestation and Compliance Audits (Carelon Behavioral Health)

What Happened

Carelon Behavioral Health has reinforced its expectations around provider directory accuracy, pointing to requirements under the No Surprises Act (Consolidated Appropriations Act). Under this federal law, providers must review and attest to their directory data every 90 days. Carelon has also made clear that it conducts directory accuracy audits on behalf of states, federal entities, health plan clients, and accreditation bodies — and that provider participation in these audits is not optional. Providers who do not maintain current data risk both compliance exposure and reduced member access.

What Providers Should Watch For

Audit outreach can come in different forms. Most providers will receive email invitations to participate in a directory verification. Larger group practices may also receive phone calls. Providers who offer telehealth or hold multi-state licenses should be prepared to complete more than one audit per year, since each credentialed plan may trigger a separate review. In addition to directory audits, Carelon may send separate requests to verify compliance with appointment access and availability standards — these are distinct from the directory attestation process. 

The directory is the primary tool members use to search for and select a provider. Outdated or incomplete information — wrong hours, missing telehealth options, incorrect languages — directly affects whether members can find and connect with you. It also affects Carelon's ability to demonstrate network adequacy to regulators.

What to Do

Start by reviewing your own listing in Carelon's provider directory to see exactly what members see. Confirm that all location details are accurate: in-person versus telehealth availability, physical accessibility features, hearing accommodations, languages you and your staff speak fluently, and whether you work with translators. These details matter to members choosing a provider and to auditors verifying network compliance.

For the 90-day attestation cycle: if you use CAQH, submit your updates and re-attestation through CAQH ProView. If you do not participate in CAQH, log in to Carelon Behavioral Health's ProviderConnect portal and update your demographic information there directly. A new provider data portal is also in development and expected to further streamline this process.

If you run into technical issues during an update, contact Carelon directly at 800-397-1630 rather than leaving the update incomplete.

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