Case Study
Health Plan Achieves 84% Directory Accuracy for Medicare Advantage Plans
A large national health plan needed to improve the quality of its directory data for Medicare Advantage plans, reduce CMS audit risk and improve member satisfaction. Provider outreach efforts to improve data quality improvement were costly and were not achieving desired results. The plan partnered with CAQH to execute a pilot initiative across the state of Texas to replace outreach calls with system-generated messages - only to providers with missing our outdated records.
The Challenge
This plan was making 1.2 million phone calls to every provider office to confirm the provider was practicing at that location.
Although the phone calls resulted in small directory improvement, the approach was resource intensive, costly and accuracy increases were not sustainable.
The Solution
Increased Provider Satisfaction
CAQH sent Net Promoter Score2 surveys to providers to find out how they felt about the new directory management process.
The survey asked, “What do you value the most about the CAQH Directory Management Solution?” Providers gave high marks for usability and how easy it is to share data with multiple plans.
“Simple,” “Easy,” “All-in-one,” and “User friendly” were the top responses.
The Results
incorrect directory records were deleted
or 40,000 providers
completed profiles and attested to the accuracy of their data in just three months
data accuracy
was achieved for the pilot provider directory records.
the Net Promotor Score®
indicating strong provider preference for the CAQH solution
Driving change with technology
CAQH solutions automate workflows, deliver a wealth of accurate and actionable data, and create a better experience for both providers and health plans.
Find out how better data can transform your directories.