CAQH Convenes Alliance to Improve Accuracy of Healthcare Provider Data

June 2017

CAQH has convened a cross-section of healthcare leaders to improve the accuracy of provider data for both industry stakeholders and patients. The Provider Data Action Alliance will develop a roadmap that articulates a vision and actionable strategies for obtaining and sharing better information. Alliance participants represent health, dental and vision plans; provider organizations; health systems; government; and health information exchanges.

The Alliance was a result of the 2016 Provider Data Summit, a CAQH-hosted conference where more than 100 industry leaders met to discuss provider data challenges. Attendees reached agreement on the priorities for improving provider data and called for further industry-wide collaboration. Summit discussions were informed by a white paper created by CAQH with support from Manatt Health, a leading health policy and research firm.

High-quality provider information is essential to conducting many of the foundational processes in healthcare, from paying claims to producing provider directories. Despite the considerable investment by the healthcare industry to attain and manage that data – currently estimated at more than $2 billion annually – there is still a high likelihood of inaccuracy. For example, a report released earlier this year by the Centers for Medicare & Medicaid Services found that 45.1 percent of practice locations listed in on-line provider directories were incorrect.

Working together, Alliance participants will develop strategies to address the challenges of ensuring accurate and timely provider information. These include managing data that changes frequently due to practice location moves, retirement or other life events. In most cases, providers must inform a number of health plans and healthcare organizations of each change, a redundant process that adds to the administrative burden for providers. Requirements for data collection vary depending on the stakeholder and state regulations. The need to increase provider engagement in the maintenance process is another key issue and focus of the Alliance.

Through this effort, the Alliance will explore how best to develop industry-accepted data definitions, improve maintenance processes and accountability measures, centralize data resources and foster greater regulatory alignment.

CAQH will facilitate the work and development of the roadmap with the Alliance through the summer, with release scheduled for fall 2017.

Learn more about the Provider Data Action Alliance and the challenges of maintaining provider data at www.caqhproviderdata.org

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