Improving provider directory accuracy continues to be an industry-wide challenge. Periodic reviews from the Centers for Medicare and Medicaid Services (CMS) have intensified pressure on health plans to improve the quality of directories. Plans allocate significant resources to these efforts, which are a portion of the $2 billion spent annually by the commercial healthcare industry to maintain provider data.
CAQH recently surveyed health plans to learn more about their strategies for improving the quality of directory data. At least half reported being audited since January 2016 when the CMS regulations were announced. Nearly 70 percent of those health plans said they are measuring the accuracy of their directories quarterly or monthly, and in some cases more than once each month. Only 1 out of 5 health plans have experienced significant improvements as a result of their efforts, noting phone, mail and fax outreach were the most effective methods for updating the information.