Comprehensive, robust provider directories are an invaluable tool for helping members find the right care. Yet maintaining this information is complicated when you consider:
- 20 percent of physicians change their address and/or phone number
- 30 percent change their health plan, hospital or group affiliations
- 5 percent have status changes (licenses, sanctions, retirement)
- False information can result from data entry errors and poor data matchup
The Centers for Medicare and Medicaid Services (CMS) emphasized increased scrutiny on provider directory data quality in its April 6, 2015 letter. CMS is focused on driving greater data cleanliness and granularity so that consumers have the information they need to choose the right providers. Doing so requires:
- Network adequacy and access: Monitor network adequacy constantly and increase frequency of adequacy data refreshes.
- Monthly directory updates: If you haven’t already, consider overhauling existing processes to move toward reducted processing times for changed data. Transitioning to delta (change) file processing and service-based data exchanges can help in these efforts.
- Quarterly provider contact: More meaningful, more frequent coordination between you and your providers is important. When speaking to providers about an issue, take the time to confirm their contact information and preferred method of communication.
- Online provider directory content: Quarterly provider contact and monthly turnaround time for directory updates help relay verified, clean data to consumers quickly. Leverage electronic capture capabilities to decrease inaccurate data and improve turnaround time.
The three C’s of provider data
It’s important to understand where your provider data ranks according to the three C’s:
- Complete: Is your data complete? Do you have missing spreadsheet data? What percentage of email addresses are you missing?
- Correct: Is your data accurate? The cells may be complete, but have you verified that the information is correct?
- Consistent: Is your data formatted to eliminate versions of the provider’s name and/or address?
The power of proactive data management
Consistent and accurate proactive data management has strong transformative possibilities for your enterprise:
- Provider source of truth: With data becoming the ultimate source of truth about providers, data quality and management gain primary importance.
- Future health strategies: Newly enhanced data provides critical inputs into strategic initiatives, such as participation in health care exchanges, development of ACOs and more strategic management of provider networks through enhanced analytics.
For a deeper dive into strategies that meet provider directory data quality guidelines, download “Provider directory data management: Integrating the latest CMS and state requirements.”
About the authors
David Mauzey, General Manager, Optum Provider Network & Data Management
David Mauzey is the General Manager of Optum’s Value Based Care(VBC) & Provider Network Data Management (PNDM) suite of solutions and services that include the PNDM platform, VBC products and Bundled Payment solutions.
Joel Haugen, Consulting Practice Lead, Network & Payment Innovation
Joel Haugen leads Optum Consulting’s Network & Payment Innovation practice. Joel has over 15 years of consulting and health care experience spanning delivery, solution architecture, design and business development.