The American Medical Association (AMA) and Lexis Nexis Risk Solutions have partnered on a project to improve the accuracy of provider directories while minimizing the cost and administrative burden for providers, Shelby Livingston writes for Modern Healthcare.
Provider directories often riddled with inaccuracies
According to Livingston, health insurers' provider directors often contain inaccuracies that can leave consumers confused or even facing unexpected out-of-network bills. For instance, a January CMS report found that "45.1 percent of provider directory locations listed in (Medicare Advantage) online directories were inaccurate," with inaccuracies ranging from erroneous addresses to misidentifying providers that were accepting new patients.
Part of the problem, according to Livingston, is the administrative burden of verifying and updating the directories. She explains that providers frequently move, often practice at multiple locations, and work with an average of 12 different health plans. Josh Schoeller, the VP of client engagement at LexisNexis Health, said, "You can imagine if you have 12 different plans that you're working with and you have 50 providers at a location, the amount of administrative burden and disruption that causes those offices."
According to Schoeller, the issue has become a consumer concern, as patients increasingly rely on the directories to help them pick out plans via the Affordable Care Act's (ACA) insurance exchanges or through their employer.
Federal and state officials have taken strides to measure and improve provider directory accuracy, Livingston writes. For instance, CMS in 2016 piloted a program assessing the accuracy of provider directors for Medicare Advantages and Part D plans and put Anthem, Aetna, and Humana on notice to resolve issues. Meanwhile, HHS requires that insurers participating in ACA marketplaces publish provider directories and update the information at least once per month.
And at the state level, according to the National Conference of State Legislatures, at least 28 states and the District of Columbia have legislation addressing network adequacy, while some states—including California and New Jersey—have implemented rules to help ensure directories are accurate.
How AMA and LexisNexis intend to fix the problem
Still, errors in provider directories remain commonplace. To help fix the problem while minimizing provider burden, LexisNexis created VerifyHCP, a product that annually reviews more than 2,000 data sources—including network data from more than 70 health plans and medical claims information—to track and collect clinician data.
The tool then pre-populates an online portal with the relevant information for each provider. "We want (providers) to be able to look at their information and verify it versus giving them a blank form to fill in that takes them a lot of time and lends itself to data entry errors," Schoeller said.
LexisNexis also minimizes the number of times a provider has to review the data: Instead of several separate insurers asking a provider to verify the information in their individual directories, LexisNexis will reach out to the provider once and then share the verified data with all the providers' contracted health plans. LexisNexis reaches out to providers by phone, email, or fax, Livingston writes, and the company reported a 79 percent response rate during the first three months of the program.
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