BetterDoctor’s Data Validation Work Helps AHIP Health Plans Comply with Provider Directory Regulations

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Independent Report Evaluates AHIP-Led Provider Directory Pilot’s Successes and Challenges

America’s Insurance Plans released an issue brief today, conducted by the NORC at the University of Chicago, which finds challenges and opportunities to improve provider directories. The brief is an independent evaluation of an AHIP pilot during April-September of 2016 with member health plans and evaluates the competitively selected data validation work of BetterDoctor and Availity.

BetterDoctor worked with nine health plans in California and Indiana. Plans included Blue Shield of California, Anthem, Health Net, Humana, SCAN, LA Care, Western Health, and Molina Healthcare.

Read AHIP’s summary: https://ahip.org/provider-directory-initiative-key-findings/
Read the issue brief: https://ahip.org/wp-content/uploads/2017/03/ProviderDirectory_IssueBrief_3.7.17.pdf

To recap, AHIP’s provider directory pilot goals were:

  • Improve the accuracy of provider directories to benefit consumers regardless of whether they are covered by private insurance or public programs such as Medicare and Medicaid;
  • Reduce the number of provider calls and contacts and develop a more efficient approach for providers to update their information for ALL plans; and
  • Test different approaches to identify the most effective path to a potential solution at a national level.

The pilot was part of an industry wide effort to improve consumers’ access to care and provide them with the information needed to make informed healthcare decisions. BetterDoctor and Availity proactively approached providers and their staff with phone calls, faxes, emails, and alerts within existing online portals asking them to update important data – such as address, phone number, specialty, and type of insurance accepted. Health plans were then able to process information about new locations and contact information to update their provider directories.

The NORC’s analysis found that BetterDoctor reached out to 109,857 providers, out of which over 47.5% provided at least a partial response to validation questions and 18.4% responded to a full set of data validation questions. Availity notified an estimated 51,071 providers, out of which 18.6% submitted a provider directory attestation.

Health plans that worked with BetterDoctor faced challenges working together — like dealing with differing data file formats in their unique internal processes — yet they made big strides as they found iterable processes that worked due to BetterDoctor’s agile response and customized service to each health plan. Most health plans that worked with BetterDoctor during the pilot have signed on to continue their work and expand to other states.

“BetterDoctor has learned a ton from this pilot. We’re excited to double down on our work to expand and serve health plans at a national scale. We are committed to help health plans meet their regulation needs and improve provider directories,” said Ari Tulla, CEO and Co-Founder of BetterDoctor.

“Health plans are committed to improving their directories and will continue to identify best practices for updating and maintaining this important information for consumers,” says Jeanette Thornton, Senior Vice President of Health Plan Operations and Strategy at America’s Health Insurance Plans (AHIP).

The pilot demonstrated three major lessons. First, there is a strong need to provide more education for providers who are largely unaware of their responsibility to respond and update their information with health plans. Second, managing this data is a complex operation for health plans and standard formats may help ease this burden. Lastly, a variety of outreach methods are needed to connect with providers to make sure information is up to date.

The Centers for Medicare and Medicaid’s most recent audits in January 2017 have shed more light on provider directory challenges for health plans. BetterDoctor understands that building the processes and optimal outreach methods to maintain fresh and up-to-date information on provider directories is costly but an urgent problem to solve. Provider data validation and improvement is more important than ever.