Categorized Directory

Main Menu

  • Home
  • Search directory
  • Web crawlers
  • Collect data
  • Indexation
  • Bankroll

Categorized Directory

Header Banner

Categorized Directory

  • Home
  • Search directory
  • Web crawlers
  • Collect data
  • Indexation
  • Bankroll
Search directory
Home›Search directory›How to Fix Persistent Inaccurate Health Plan Directory Issue

How to Fix Persistent Inaccurate Health Plan Directory Issue

By Ed Robertson
January 19, 2022
0
0

As patients use a variety of search engines, physician rating websites, and social media platforms to find physicians who meet their needs, they often turn to health plan directories to take the final decision. Patients rely on directories to identify clinicians based on specialty, location, hours, and health plan participation. They also consult directories for information on languages ​​spoken, special skills and experience, availability of telehealth or LGBTQ+-friendly services.

But too often the directories contain erroneous or outdated information. This can lead to patient frustration, delays in care or unforeseen disbursements. In fact, a 2020 Health Affairs The study titled “Incorrect Provider Directories Associated With Out-Of-Network Mental Health Care And Outpatient Surprise Bills” showed that 53% of patients seeking such care in health plan directories found inaccuracies. Centers for Medicare & Medicaid Services audits of online Medicare Advantage plan directories found similar error rates.

This problem has persisted despite efforts by policy makers and health plans to address it.

A new document from the AMA and CAQH highlights the need for alignment between health plan and physician practice, automation and a streamlined process to produce accurate directories. It also highlights the issues and recognizes the responsibilities of the players serving patients.

Related coverage

4 ways the AMA fought in court to preserve access to care

Fragmented data creates a challenge

Fragmented data creates a challenge

Health insurance plans rely on physician practices to notify them of changes in practice information. Although it sounds simple, practices contract with more than 20 plans on average and can be inundated with requests for updates by phone, email, or health plan-specific portals. Some medical practices also report that the updates they provide do not always appear in directories.

Problems also persist because practice information changes frequently, increasing the possibility of errors. Studies show that between 20% and 30% of directory data changes every year.

Finally, the newspaper explains that no party is the exclusive holder of this information. Doctor’s offices maintain contact information and the group list, but health plans control information about doctors on contract and often locations covered by the contract. Information about which doctors are accepting new patients covered by which health plan, meanwhile, is controlled by both parties.

Related coverage

Competition continues to shrink in U.S. health insurance markets

Roadmap to greater directory accuracy

Roadmap to greater directory accuracy

The AMA and CAQH outline solutions to ensure patients have access to accurate information in health plan directories.

The paper asks:

  • Identify the respective responsibilities and the best approaches to fulfill these responsibilities.
  • Establish data governance standards that incorporate legacy data silos.
  • Identify greater opportunities to streamline health plan data requests so that practices can provide data through fewer and more consistent update channels.
  • Harmonize data systems to facilitate better quality data and facilitate the development of bulk and real-time updates.
  • Agree on a minimum set of repertoire data and accept shared responsibility for producing, managing and presenting accurate data to patients.

The article concludes that past efforts to improve the accuracy of directories have been hampered, in part, by a lack of shared understanding and accountability between clinicians and health plans, a lack of data standards, and fragmented systems. to collect and transmit this information. This situation is exacerbated by already burdensome administrative requirements. By working together, health plans, clinicians and practices now have the opportunity to solve this problem for patients once and for all.

Learn more about what the AMA is doing to make network directories accurate and accessible.

Related posts:

  1. Google warns against manual actions for UGC spam
  2. Expecting a baby? Doulas supports your comfort, safety and health
  3. New names debut on BizWest’s list of public companies – Loveland Reporter-Herald
  4. Update of the Madison Canadian Sawmills Registration Directory * coming soon *

Categories

  • Bankroll
  • Collect data
  • Indexation
  • Search directory
  • Web crawlers

Recent Posts

  • Live-Action TV Spider-Mans Who Didn’t Appear in No Way Home
  • Bennet bill would create federal definition of school shooting, direct incident data collection
  • The 10 Most In-Demand Entry-Level Remote Jobs Landing Right Now
  • Face-Scanner Clearview accepts the limits of the legal settlement | Economic news
  • Ex-minister embroiled in Hellenic row over staff cuts

Archives

  • May 2022
  • April 2022
  • March 2022
  • February 2022
  • January 2022
  • December 2021
  • November 2021
  • October 2021
  • September 2021
  • August 2021
  • July 2021
  • June 2021
  • May 2021
  • April 2021
  • Privacy Policy
  • Terms and Conditions