CAQH is Simplifying Provider Directory Maintenance with DirectAssure

March 2016

Responding to consumer concerns about the quality of healthcare provider directories, a number of federal and state directory requirements have recently gone into effect. Health plans must now regularly update and confirm the accuracy of their provider information, or face potential penalties. CAQH is helping health plans address these requirements with the launch of DirectAssure, which works in concert with CAQH ProView to improve provider directory data. This latest CAQH Solution eliminates the need for each health plan to reach out to the individual healthcare providers in their network to obtain updates, and reduces the burden on providers that such redundant outreach would require.

DirectAssure enables the more than 1.3 million providers participating in CAQH ProView to easily review and update their self-reported professional data for use in directories. CAQH estimates that administrative savings from the use of this centralized solution will exceed $90 million for every one million providers participating.

Healthcare providers currently log in to the web-based CAQH ProView frequently to review and attest to their full professional profile for credentialing purposes. Providers designated by participating plans will now be contacted by CAQH at least quarterly and asked to review, update and confirm a specific subset of those data elements in a “Provider Directory Snapshot” for use in provider directories. This data includes provider location, contact information, specialty, medical group, institutional affiliation and whether they are accepting new patients.

In this one-to-many approach, providers can update their directory information in one place; the data is then made available to participating health plans that providers have designated to receive their information. As with CAQH ProView, all healthcare providers are able to participate without charge.

CAQH began development of this new initiative in 2015 by engaging a group of experienced provider directory staff from member health plans to provide insight and expertise. Successfully tested in a pilot program, DirectAssure launched in February with participation from CAQH member plans including Aetna, Blue Cross Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna-HealthSpring, Horizon Healthcare Services, Inc., Kaiser Permanente and UnitedHealthcare. The solution is now available to all health plans.

The solution launched as requirements for provider directories increase. The Centers for Medicare & Medicaid Services (CMS) announced that it will require updates of provider information at least quarterly for all Medicare Advantage health insurance plans. Plans that do not comply may face penalties. Requirements for Qualified Health Plans (QHPs) participating in the Federally Facilitated Marketplace also recently went into effect.

Additionally, 26 states now have requirements for timely directory updates and the National Committee for Quality Assurance (NCQA) will implement directory audit process standards for health plans accredited by that organization beginning in July 2016.

To learn more about this new CAQH initiative and view the health plans currently participating, visit caqhdirectassure.org.

Type: 
Audience: 
Organization Type: 
CAQH Program: