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CAQH Provider Directory Solution Demonstrates High Provider Engagement

One year after its launch, DirectAssure has become an important resource to help health and dental plans improve the quality of their provider directories. More than 500,000 healthcare providers have reviewed, updated and confirmed their professional information for use in directories, and more than 30 health and dental plans are already participating in this industry-wide solution.

This initiative leverages the professional data that more than 1.4 million healthcare providers already submit into the web-based CAQH ProView system for credentialing and other business needs of health plans, hospitals and health systems, and large provider groups. Because those providers routinely engage with CAQH ProView to review, update and re-attest to their practice information, their participation in DirectAssure has been particularly strong since it requires little additional work. In fact, almost 80 percent of providers who have been contacted by CAQH for purposes of updating their directory information respond after only one email.

In the past two years there has been exponential growth in both federal and state regulations focused on provider directories. The Centers for Medicare and Medicaid Services (CMS) now requires updates of provider information at least quarterly for all Medicare Advantage plans, and requirements for Qualified Health Plans (QHPs) participating in the Federally Facilitated Marketplace have also gone into effect. Twenty-six states and the District of Columbia have enacted legislation or regulations that require health (and dental plans in some cases) to take specific actions to improve their directory accuracy, and at least four of those states are considering additional requirements.  

CMS conducted a series of audits of health plans in 2016 to check the quality of their provider directories, and found that almost half of locations were incorrect.[1] These errors included providers not practicing at the location listed, or not accepting new patients when the directory indicated they were. Of the 54 plans reviewed, 21 received warning letters from CMS in January 2017 with instructions to improve their directories or face future fines.  

DirectAssure has proved to be especially helpful in enabling health plans to suppress incorrect practice locations. An audit conducted by a national health plan compared their own provider directory against Direct Assure. They found that, if their directory had locations not present within DirectAssure, then 80 percent of those locations should be suppressed. 

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[1] Online Provider Directory Review Report. Centers for Medicare and Medicaid Services. January 13, 2017.