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Data Quality Improves with DirectAssure Enhancements

In its second year of adoption, DirectAssure has established itself as a leading solution for health plans to address the ongoing challenge of maintaining accurate provider directories. Making changes to directory information is seamless for healthcare providers, who use CAQH ProView to easily review and update their professional information. DirectAssure participating organizations, including most national plans, are already using the solution to manage directory data for more than 800,000 providers. On average, about 600,000 of those providers review and confirm their information every four months, demonstrating a high level of engagement with CAQH.

Three new features released in late 2017 are improving data quality. The first feature, which resulted in an immediate 15-percent increase in accuracy, involved identifying and suppressing inaccurate practice locations – the most common error in Centers for Medicare and Medicaid Services (CMS) audits of directories. The feature presents providers with a series of questions to confirm that practice phone numbers can be used for scheduling appointments and that providers regularly treat patients, and take appointments, at the locations listed. In only five months, DirectAssure identified one million locations that should be suppressed in directories.

The second feature reconciles information discrepancies between plans and providers. Plan directory data in DirectAssure is now compared to CAQH ProView provider profiles, and differences are presented to the provider to accept or amend. Corrections are applied to the profile and made available to participating plans. Recent audit results for one large health plan demonstrated a 35-percent increase in location accuracy.

The third feature enables providers to easily confirm that they are participating with a health plan and accepting new patients covered by that plan. Plans use this data to address misalignment between contract terms and provider responses, and update their directories.

Learn more about these and other DirectAssure features in an on-demand webinar featuring Cigna-HealthSpring.