Payer, Provider Collaboration May Improve Provider Directories

Health plan provider directories can be a helpful resource for patients, but they are not always accurate. A shared effort from health plans and providers that includes streamlining data collection and providing timely data updates can help improve health plan provider directories, according to a white paper from CAQH and the American Medical Association (AMA).

Individuals use health plan provider directories to find information about in-network providers, such as their location, phone number, specialty, and if they are accepting new patients. Directories may also yield additional information about providers, including the languages they offer and their experience with certain populations.

However, past audits have shown that health plan provider directories tend to have at least one inaccuracy, which could lead to poor patient experience and financial repercussions.

Under the No Surprises Act, commercial health plans must record changes to clinician and practice information within two days, but not all plans have the administrative support to comply with the regulation.

“Health plans and practices will continue to encounter these challenges unless they can work together in a coordinated way,” the white paper stated. “It starts with identifying the respective responsibilities of each party and the best approaches to execute on those responsibilities.”

Health plans can start by streamlining their data collection methods to simplify the process for practices. By using fewer update channels, health plans may create a smoother method for providers and eliminate data silos. Additionally, streamlining data collection could help lead to integration that allows for real-time data updates and automation.

In order to improve provider directories, health plans can also provide more usable plan information and work with providers to determine how this information is presented in the directory. By offering clearer information, patients may be able to find what they are looking for more easily and access care in a timelier manner.

Adequate communication and transparency between health plans and practices are key to ensuring provider directories are accurate, AMA said. If health plans come across directory issues from practices, timely communication and coordination can help resolve the problems, generate positive feedback, and lead to higher quality data.

Similarly, practices should notify health plans of any issues on their end that patients are experiencing with a health plan directory in order to resolve the errors.

In addition, health plans can utilize industry-wide data quality assessments and benchmarking to monitor their performance.

Practices should follow a set of guidelines to ensure provider directory success as well.

Directories cannot display provider information without practices consistently providing updated addresses, phone numbers, and new patient statuses.

A notable issue that patients tend to run into on provider directories is location discrepancy. To help address these inaccuracies, practices should submit location information that reflects where clinicians regularly see patients and not include any locations where the clinicians may offer services only occasionally.

If health plans offer the option to indicate that a physician is affiliated with a location but does not practice in that location, practices should ensure to provide accurate information.

“Communicating these indicators accurately to health plans will minimize their risk of denied claims due to unlisted practice locations and ensure that health plans are publishing accurate directory information for patients,” the white paper stated.

Providers, like health plans, may also benefit from streamlining their data submission processes. This may require enhanced integration between their marketing and health plan enrollment departments to facilitate the submission of practice data to health plans.

Practices should also ensure that they are sourcing their data from internal systems that support similar use cases like appointments and doctor searches.

“Previous efforts to improve directory accuracy have been stymied, in part, by a lack of shared understanding and responsibility between clinicians and health plans and a lack of data standards and fragmented systems to collect and transmit this information,” the authors concluded. “By working together, health plans, clinicians and practices now have an opportunity to solve this persistent problem for patients once and for all.”