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How Dental Plans Can Improve Provider Data Management

According to a recent CAQH ProView® provider data analysis, dentists who share their professional and practice information with multiple plans using a single platform are far more likely to keep their information updated than those who use multiple methods.

Specifically, almost 90 percent of dentists who use ProView to share provider data with 10 or more dental plans, keep their profile current — meaning they attest to the accuracy of their self-reported data every four months.

Why? Because a single platform for credentialing, adopted by both dental plans and dentists, offers a solution to a problem that has been at the root of provider data management.

Today, dental plans collect provider data using different methods and platforms and on varying cycles. Dentists who participate with multiple plans face an ongoing stream of requests which add a significant administrative burden and cost to running their practice. Put simply, dentists and practice administrators have a natural incentive to remain engaged when using a method that saves them time and money.

For dental plans who leverage provider data for many essential business processes, such as credentialing, directories, payment and others, this insight has significant implications. Simplify the redundancy associated with provider data gathering to unlock greater participation and engagement from your network.

While the industry spends more than $2 billion annually to maintain provider data, inaccuracies and inefficiencies persist. One common inefficiency is related to overlapping data sets. For example, while maintaining directories and credentialing both utilize data regarding demographics, contact information, sanctions and specialties, many plans use different vendors, in-house departments, portals and platforms for each. Not only is this costly and inefficient, but it can also lead to inconsistent information about the same dentist across systems managed by a single dental plan.

Poor data quality not only undermines essential business processes but can also expose plans to regulatory risks. In the context of credentialing, numerous contractual and regulatory requirements obligate dental plans to ensure that contracted dentists are legally qualified to practice. In the context of directories, at least several states mandate dental plans ensure accurate directory information on a timely basis. Above all, consumers expect that their plans provide access to accurate network directories with licensed and qualified dentists whom they can turn to for their dental care.

For dental plans, a consolidated provider data management solution would address many of the underlying challenges related to maintaining accurate provider data. Similarly, a single platform through which providers can share information with all contracted plans would dramatically reduce the burden on dental practices and incentivize participation and engagement.

CAQH Proview, used by more than 1.6 healthcare providers and over 1,000 healthcare organizations, is the premier provider data source for credentialing and is also used by health and dental plans for network directories, claims processes, quality assurance, emergency response, member services and more.

Dental plans participating in CAQH ProView save on re-credentialing costs, substantially reduce the processing time for initial credentialing applications, and improve their provider data quality.

To learn more about ProView for dental plans, visit our product page.