Health Plan Strategies to Improve Directory Accuracy

December 2017

Improving provider directory accuracy continues to be an industry-wide challenge. Periodic reviews from the Centers for Medicare and Medicaid Services (CMS) have intensified pressure on health plans to improve the quality of directories. Plans allocate significant resources to these efforts, which are a portion of the $2 billion spent annually by the commercial healthcare industry to maintain provider data.

CAQH recently surveyed health plans to learn more about their strategies for improving the quality of directory data. At least half reported being audited since January 2016 when the CMS regulations were announced. Nearly 70 percent of those health plans said they are measuring the accuracy of their directories quarterly or monthly, and in some cases more than once each month. Only 1 out of 5 health plans have experienced significant improvements as a result of their efforts, noting phone, mail and fax outreach were the most effective methods for updating the information. 

These efforts have resulted in provider practices fielding outreach from multiple health plans, all seeking the same information, and increasing the burden on practice staff. The outreach also requires a high-level of health plan resources.

To address these challenges, CAQH launched DirectAssure last year, which leverages data from CAQH ProView for accurate directory maintenance. CAQH conducts outreach to providers aligned with regulatory reporting requirements prompting them to review, update and attest to their practice information. When they update that data, it can then be shared with all participating health plans that have the provider in their network.

Location accuracy remains a particular challenge. In its 2017 report, CMS found that at least 45 percent of the locations reported in directories are incorrect. Most often this can be attributed to the provider not actually practicing at the published location.

CAQH has recently enhanced the functionality in DirectAssure to address the location challenge and better enable health plans to meet regulatory requirements. New location-specific questions ask providers to accept or reject location information, and require a reason for rejections. The responses are sent to participating health plans which can then reconcile any discrepancies.

A number of health plans are now using DirectAssure as part of their directory maintenance strategy. In a recent webinar with CAQH, Cigna-HealthSpring reported a 20 percent increase in data accuracy since January 2016. To learn more about their efforts to manage provider directories, download the webinar.

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