About CAQH

For more than 20 years, CAQH has helped nearly 1,000 health plans, 1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently. CAQH technology-enabled solutions and its Committee on Operating Rules for Information Exchange (CORE) bring the healthcare industry together to make sharing business information more automated, predictable and consistent. CAQH Explorations researches opportunities to reduce the burden of manual processes in healthcare administration. Visit www.caqh.org and follow us on Twitter: @caqh.

Streamlining the way directory information is collected and shared with health plans can improve accuracy and save physician practices more than $1.1 billion

WASHINGTON, DC - 11/13/2019

CAQH® today released results of a survey of providers across the US that revealed the administrative burden associated with maintaining provider directories. The survey of 1,240 physician practices, conducted in September 2019, determined that directory maintenance costs practices nationwide $2.76 billion annually. Updating directory information costs each practice $998.84 on average every month, the equivalent of one staff day per week.

"Our nation's fragmented approach to maintaining provider directories is not only a burden on physician practices, it may be undermining the accuracy of the data," said April Todd, CAQH Senior Vice President for CORE and Explorations. "Health plans rely on the information providers give them. If we minimize the requests that drive provider burden, we can improve the accuracy of the data."

The burden associated with directory maintenance is due, in part, to the fact that the average physician practice updates information for 20 health plan contracts, according to the survey. Large practices may have more than 30 health plan contracts. Although individual health plans have worked to minimize the burden on providers in their network, practices must still respond to multiple requests and submit information in varying formats and on different schedules for each plan. This taxes practice resources and can result in errors.

Studies of online directories for Medicare Advantage plans conducted by the Centers for Medicare and Medicaid Services (CMS) found that as much as half of the information contained in directories may be inaccurate. Because members rely on directories to identify and contact providers in their plan, inaccurate directories can present a barrier to care and result in higher out of pocket costs.

In spite of these challenges, providers see the importance of accurate directories. In a survey released by the American Medical Association (AMA) in January 2018, 52% of physicians said their patients encounter coverage issues at least once a month due to inaccurate directories. To address this problem, 67% of physicians surveyed by the AMA expressed an interest in having their practice use just one interface to send and update information to payers.

To determine whether a single platform would reduce administrative burdens, CAQH examined how providers submit similar information for credentialing, in which many practitioners use one channel to provide updates to all of the health plans with which they contract. CAQH determined that practices that use one channel for all plans spend 39.6% less per month than those who use multiple approaches.  Assuming similar efficiencies, using a single channel to update directory information could save the average physician practice $4,746 annually. Nationwide, streamlining directory maintenance through a single platform could save physician practices at least $1.1 billion annually.

"This is going to take an industry-wide solution," said Todd. "If payers along all lines of business work together to reduce the burden on providers through a single streamlined approach, we can improve the accuracy of directories for all consumers."

Read the white paper: "The Hidden Causes of Inaccurate Provider Directories"