A lot is riding on the accuracy of the online healthcare provider directories that insurance plans maintain. Practitioners consider them an essential source of new patients. Plan members rely on them to find in-network doctors who meet their needs. And the plans themselves see them as an essential source of connection to their customers.
When so many have a stake in the accuracy of provider directories, why do they still frequently suffer from outdated or otherwise compromised data? Recent research from Atlas Systems found that almost 40% of provider directory listings are misleading – and the proportion may well be rising. With so much to lose, why are directories still delivering incorrect information and disappointing experiences? Let’s look at just a few of the factors in play.
Lack of Communication
The timely flow of information from healthcare providers to health plans has become a major stumbling block in the drive to maintain accurate directories. A doctor or specialist may have left a particular network and failed to inform the health plan of the change. And with so many plans seeking the latest information – often using very different forms and requests – providers are hard-pressed to keep everyone up to date.
The No Surprises Act has raised the ante when it comes to provider data management, demanding that plans and providers work together to ensure directories are updated every quarter. But, as we saw in a recent Atlas Systems webinar, both sides are often struggling with a lack of resources, training, and time.
Too Much Information
While health plans are often waiting on information from time-crunched providers, the opposite can also be true – that insurance companies simply do not have the people and technology needed to handle all of the data coming in from doctors and other practitioners. From the health plans’ perspective, they manage tens of thousands to upwards of a million or more provider records at any given time. Additionally, providers are giving health plans thousands of updates weekly or monthly.
There’s also the continuous process of evaluating feedback from members who have identified incorrect provider data. Remember, too, that this data is only as up-to-date as when recorded. While health plans may attempt to validate data more often, this is a difficult road to climb.
Data Silos
Many providers and health systems have organized key aspects of their data into silos, with one containing credentialing information about the provider, one containing contracting information specific to their relationship with health plans, and another for scheduling appointments with patients.
The data a health plan needs to keep a provider’s information up to date in their directory may also be split between multiple silos which adds an additional challenge for providers to share their data with health plans.
However, this issue is not limited to providers and health systems. Many health plans also have internal data silos which can contribute to a lack of timeliness in accurate data from providers appearing in a health plan’s provider directory. The interactions between these data silos can also result in inaccurate provider data being mistakenly used in place of correct information.
What Health Plans and Providers Can Do
Finding a balance is the first step toward greater patient satisfaction and a higher standard of member experience. Direct communication between providers and payers can reduce the risk of low-quality data. A direct outreach model simplifies managing and maintaining data as much as possible. Technology solutions like data analytics, artificial intelligence (AI), and machine learning (ML) help automate error-checking and provide insights into data handling that may further streamline the validation process. And third-party services, like Atlas Systems’ PRIME, can provide relief with proven methods for improving provider network management.
Taking provider data accuracy to a new level is a shared responsibility – and, with the right partners and programs, it is more than possible!
John K. Lamb worked for over 40 years within major health insurance companies, taking on key claims, provider, and compliance issues. He is now Vice President of Provider Operations at Atlas Systems, working on our PRIME service.
