Provider directory accuracy is an important topic for consumers, providers, and payors. It’s obviously very important to us, too – in fact, nearly half of our employees are focused on data accuracy and integrity every day.
That’s why we’re following the progress of federal and state regulatory initiatives around ensuring accuracy very closely. I came across an article from Medicare Advantage News (login required) recently that summarizes official remarks at the Medicare Advantage and Prescription Drug Plan fall conference discussing the pilot program conducted by CMS’ Medicare Drug & Health Plan Contract Administration Group to assess directory accuracy. In this initial program, they found:
- Nearly half (46%) of locations had errors meaning that at least one data element in the directory for that location was inaccurate. Most of the organizations reviewed were 20%-60% inaccurate.
- Two-thirds of the deficiencies involved listing providers at locations where they don’t practice.
- Ten percent of the deficiencies were incorrect phone numbers.
- Twelve percent of the deficiencies were incorrect addresses, including incorrect suite numbers.
The study focused on large organizations with multiple locations and many providers, ultimately contacting nearly 6,000 primary care physicians, oncologists, ophthalmologists, and cardiologists at 11,646 locations. Based on our experience with directory data, inaccurate data is more likely with large practices that include many providers and locations. Take a look at our whitepaper about overstated access in dental directories for more on this subject.
Inaccurate provider directories frustrate members and providers and they also make it hard to compare your network to your competitors’ networks. Here are five best practices for managing your network data that will help you find inaccuracies in your network and make your network stand out:
- Review your directory data regularly. Be sure that provider names, addresses, and phone numbers are up to date. Transparency in your reporting will be to your advantage in the long run as it increases member and provider satisfaction by making your directory more reliable.
- Check for duplicate records that can be consolidated, especially if you are stacking networks, since it can be hard to identify providers from the vendor network that are already in the carrier network. This will also help streamline your directory validation programs.
- Adopt data standardization practices, particularly for numeric fields. For example, make sure leading zeroes on ZIP codes have not been dropped and replaced by the first digit of the ZIP+4. This is common in ZIP codes in New England, New Jersey, and US Caribbean territories. Cleaner data is easier to manage and compare.
- Consider including competitor network data in your analyses so that you understand your competitive position, predict results, and prepare for the future.
- For Disruption Reporting and Repricing, make sure that provider name data is properly parsed and address data is standardized. Use the same processes for claim and provider data files to give best chance of identifying valid matches.
How are you validating the provider demographic information in your online directory?