Collaboration is Improving Healthcare Provider Directories

January 2019

Accurate provider directory information is an imperative for the U.S healthcare system. It impacts the ability to find a healthcare provider and plays an important role in access to care. Yet, maintaining up-to-date provider directories is too often a burdensome and highly manual process for both health plans and providers.

Nationwide, policymakers and industry stakeholders are diligently working to fix this problem. Some states are taking a proactive approach and implementing a shared solution to improve provider directories.

CAQH recently announced that managed care plans in Tennessee have adopted CAQH ProView to increase the accuracy of provider data. Previously, CAQH also announced that several health plans in Massachusetts are adopting DirectAssure to improve the quality and timeliness of healthcare provider directories in New England. In both instances, health plans will work closely with the provider community to build awareness of this shared solution.

More than 1.4 million healthcare providers use CAQH ProView to share professional and practice information with participating health plans. Nearly 1,000 health plans, hospitals and provider groups are also using the solution, which saves millions of dollars in annual administrative costs across the healthcare system. DirectAssure works in concert with CAQH ProView, asking providers to compare and verify practice location information within health plan records, confirm whether they accept specific insurance plans and if they are accepting new patients.

The collaboration within these states to address inaccurate provider directories sets a model for a national approach to improving provider data quality.

Visit the CAQH website to learn more about industry-wide solutions to improve provider directories.

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