CAQH Launches New Solution to Improve Provider Directory Data Quality

Leader in Provider Data Enables 1.3 Million Providers to Use Self-Reported Information in CAQH ProView to Meet New Regulations

WASHINGTON, DC - 2/17/16

The non-profit alliance CAQH today announced a new, fully-electronic solution to improve the quality of provider data in health plan directories. Launching as regulatory requirements increase for accurate provider directory information, DirectAssure is designed to help relieve the associated burden on healthcare providers.

DirectAssure will enable the more than 1.3 million providers participating in CAQH ProView to easily review and update their self-reported professional data for use in health plan directories. CAQH ProView is currently used by more than 800 health plans and other organizations for a range of provider data needs, including credentialing.

The first health plans taking part in the new initiative are CAQH members, 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. As with all CAQH initiatives, other health plans may also participate following this initial launch.

DirectAssure will eliminate the need for each health plan to reach out frequently to the individual healthcare providers in their network to obtain updates. “We believe this initiative just makes sense. It will dramatically reduce the number of requests that providers receive for updated information,” said Barbara Derian, Sr. Director, Provider Enrollment and Credentialing, Blue Cross Blue Shield of Michigan, “And will also reduce the effort and expense required for plans to conduct that outreach.”

Patients have long expressed frustration that some provider information in health plan directories is outdated, while providers complain that the update process can be confusing and cumbersome. Directory data inaccuracies have raised increasing concerns as many Americans base their choice of plan or healthcare provider on this information.

As a result, regulatory agencies have imposed new requirements on health plans to regularly update their provider directories. 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 put in place directory audit process rules for plans accredited by that organization beginning in July 2016.

Through DirectAssure, providers designated by participating plans will be contacted by CAQH at least quarterly and asked to review, update and confirm a specific subset of their CAQH ProView data elements for use in provider directories. This data includes provider location, contact information, specialty, medical group, institutional affiliation and whether they are accepting new patients. Healthcare providers currently log in to the web-based CAQH ProView frequently to review and attest to their full professional profile for credentialing purposes. In this one-to-many approach, providers can update and confirm their directory information in one place; the data is then made available to participating health plans. Providers may designate the plans they wish to receive their information.

“We believe that collaborating with other health plans is the simplest and most efficient way to work to get accurate information and do so in a way that is easier for providers,” said James Dell’Arena, Director, Network Data Management & Medical Cost Strategy, Horizon Healthcare Services, Inc. “It has worked well in CAQH ProView, and will also help us address the urgent need for more accurate provider directories.”

As with CAQH ProView, all healthcare providers will be able to participate in DirectAssure without charge. CAQH estimates both plans and providers will save at least $90 million annually for every one million providers who use this centralized solution to confirm the directory information.

CAQH began development of this new initiative in 2015 by engaging a group of experienced provider directory staff from leading health plans to provide insight and expertise. It was further tested in a successful pilot program that included four national and three regional health plans, with outreach to more than 3,000 providers.

“The CAQH mission is to streamline the business of healthcare through collaborative, shared initiatives,” said Robin Thomashauer, CAQH Executive Director. “With the introduction of this provider data confirmation initiative, we will reduce the administrative burden on both plans and providers, help plans increase the accuracy of their directories and enable patients to make more informed choices about their care.”

To learn more about this CAQH initiative, visit CAQHDirectAssure.org.

About CAQH

CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans. Visit www.caqh.org and follow us on Twitter: @caqh.

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