What is 90-Day Update Rule?

90-Day Update Rule Definition

The 90-Day Update Rule is the "Operational Cadence" of the modern health plan. For Payer Ops, this creates a massive quarterly "Outreach Wave." Every single provider in the network must be contacted (usually via email, portal, or phone) to verify their details. If a provider fails to respond to this outreach, the plan must "flag" them or potentially remove them from the public directory. For C-level Executives, this rule demands a "Scalable Tech Stack"—trying to do 90-day updates manually for 100,000 providers is impossible. Strategically, plans are using this mandate as an opportunity to implement "Digital-First" provider relations, driving doctors to use portals and APIs for self-service data management.

FAQs

Does the 90-day rule apply to all plans?

Yes, it is a federal mandate that applies to all group and individual health insurance plans under the Consolidated Appropriations Act (CAA).

What data points must be verified every 90 days?

Name, Address, Phone Number, Specialty, and whether the provider is currently "Accepting New Patients."

What happens if a provider is "Unresponsive"?

The plan must follow a documented "Follow-up Protocol." If they still cannot verify the data, the provider must be "Suppressed" from the public directory until they comply.