May 15, 2026
Annual verification supports patient access to care and DMHC compliance
Keeping provider directory information current helps patients find care quickly and supports compliance with California state requirements.
The California Department of Managed Health Care (DMHC) has updated provider directory regulations to improve the accuracy and reliability of information used by patients and regulators. These requirements are effective on April 1, 2026, and apply to all contracted physicians, practitioners, independent practice associations (IPAs), and other providers.
Some provider directory requirements described below have existed under California law, and Senate Bill 137 (2015) further codified and modernized them beginning July 1, 2016. The DMHC’s new provider directory regulation further clarifies and strengthens those standards, effective April 1, 2026.
Failure to verify or update provider directory information may result in inaccurate listings and could impact compliance with DMHC requirements.
State requirements and annual filing
Healthcare plans are required annually to demonstrate directory accuracy to the DMHC under California law. Because plans rely on provider‑supplied and provider‑verified information, it is essential that physicians, practitioners, provider groups, and other providers:
- Keep directory information current, and
- Respond promptly to requests to verify or update information.
Accurate provider directories help patients find care, avoid delays, and support compliance with state regulatory requirements.
What you are expected to do
IPAs
- IPAs must be listed in provider directories using one of the following:
- The name filed with the DMHC as a risk-bearing organization or capitated provider group, or
- The business name registered with the California Secretary of State if the group is not registered with the DMHC. A “doing business as” (DBA) name may be used if it is registered with the Secretary of State.
- IPAs will be asked to verify and confirm their group name to ensure the correct name appears in provider directories.
Physicians, practitioners and other providers
- You are expected to regularly review your directory information, report changes as soon as they occur, and respond promptly to verification requests to ensure continued accuracy and compliance.
- When requested, verify the following information:
- Practice address(es) and phone number(s)
- Specialty
- Provider group affiliation
- Languages spoken
- Telehealth availability
- Whether you are accepting new patients
- Verification requests may be sent electronically or in writing and should be completed as soon as possible.
New patient status
Only indicate that you are accepting new patients if:
- You are actively open to new patients, and
- Patients can schedule an initial appointment without being placed solely on a waitlist.
Practice location and service type
You must accurately report how services are delivered, including whether you:
- See patients at a physical office location
- Provide services only via telehealth
- Provide services only in patients’ homes
Providers without a physical office must still confirm how services are delivered.
Report changes as soon as they occur
Delays can result in incorrect directory listings. Notify Wellcare promptly if there are changes to:
- Address or phone number
- New patient availability
- Specialty or services offered
- Practice closure or departure from the network
Email address listing
Your email address will be listed in the provider directory only if:
- You provide written consent, and
- You confirm the email is intended for patient communication and is regularly monitored.
This information applies to Physicians, Practitioners, Independent Practice Associations (IPAs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
