Health Plans Continue to Struggle with Inaccurate Provider Directories-2

Health Plans Continue to Struggle with Inaccurate Provider Directories

Unexpected medical bills are a common issue that many patients face. In 2020, the Federal government passed the No Surprises Act to protect patients from these unexpected bills and increase transparency in the healthcare industry.

The No Surprises Act included provisions requiring healthcare payers to make timely updates and maintain their provider directories in an effort to reduce surprise bills that occur when a patient unknowingly sees an out-of-network provider.

Despite these well-intentioned provisions, the reality is that many payers struggle to keep updates and accurate provider data.

To test the impact of these efforts, researchers at the University of Colorado School of Medicine deployed AI technology to analyze the plan provider directories of over 40% of U.S. physicians.

The results were quite alarming.

In over 81% of providers across five major insurers, the AI model found glaring inconsistencies within their provider directories, most of which concerned addresses among physicians listed as practicing in multiple locations.

Data inaccuracies are particularly troubling in the healthcare industry, where patients’ health is at stake. It’s a situation that no organization wants to deal with as it can lead to unexpected medical bills, delay of care for those who need it most, payment inaccuracies, and low member satisfaction.

Provider Data Best Practices

Timely provider data updates are critical, but for many organizations, the task can feel daunting with the amount of time it takes and the repetitive nature of the work. Fortunately, with the proper knowledge and tools, you can improve the accuracy of your provider data and avoid complications that could cost you patients, money, and reputation.

At HCIM, we know it can be overwhelming and complicated to keep up with the constant changes and updates to your directories. Our healthcare operations experts are ready to assist you in designing and implementing processes to ensure your organization stays ahead of the curve.

HCIM has expanded SymKey for EZ-CAP functionality to the Provider Module of EZ-CAP. Using IntelliRPA(R) technology, you can manage your data with the accuracy, consistency, and speed that many have come to expect from HCIM and SymKey. It is important to remember that tools do not run your business; the operations experience behind the technology is what makes the difference.

How Can I Get the New Provider Module For My Organization?

HCIM has been committed to providing innovative solutions to help optimize our clients’ operations for over two decades.

With the addition of our SymKey for EZ-CAP Provider Module, we now have another tool you can leverage to overcome the complexities of data management and avoid costly inaccuracies.

Don’t wait to see the benefits of our new module in action. Contact us today to learn how we can help you turn your complexity into simplicity and drive better results for your organization.