AI Technology Improving Provider Directories

March 2019

Artificial Intelligence developed by CAQH is now making it possible to increase the accuracy of healthcare provider directories, without contacting the provider.

This new technology is helping plans overcome a longstanding challenge -- Incomplete, inaccurate and outdated provider data has been a pervasive problem for the healthcare system for years. However, the stakes increased when the Centers for Medicare and Medicaid Services (CMS) began conducting annual reviews of Medicare Advantage online provider directories in 2016. Since then, failure to maintain accurate provider directory information leaves health plans subject to thousands of dollars in fines for each subscriber.

Historically, the best method to verify provider information has been to make phone calls, but that option is both expensive and burdensome. According to CAQH estimates, reducing provider outreach alone could save about $91 million annually for health plans. Total savings resulting from better data quality will likely be much higher.

CAQH AI integrates an extensive source of provider-attested data, as well as information from multiple third-party sources. The technology draws on CAQH ProView®, which more than 1.4 million providers routinely use to share professional and demographic information. Through ongoing sample audits, CAQH is continually improving the model’s identification of good and bad data. Ultimately, more accurate directory information should have a positive downstream impact on access to care.

Read the recent CAQH press release to learn more.

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