Most people with medical insurance have become frustrated at some point trying to find an available doctor in their health plan's network. They locate multiple providers in their plan's directory, and they reach out to them. All of them. But...
Flawed directories are infuriating to consumers to say the least. But they are also dangerous as they impede a patient's ability to get care. And, they signal that health insurers aren't meeting regulatory requirements.
In 2016, California implemented a law to regulate the accuracy of provider directories. That same year, the federal Centers for Medicare & Medicaid Services demanded more accurate directories for Medicare Advantage health plans and policies sold through the federal ACA marketplace. And this year, the federal No Surprises Act, took effect, extending similar rules to employer-based and individual health plans. The No Surprises Act stipulates that patients who rely on information in their provider directories and end up unwittingly seeing doctors outside their networks cannot be required to pay more than they would have paid for an in-network provider.
Laws have arrived, yet it appears to consumers that directory accuracy isn't improving fast enough. Industry analysts and academic researchers say this may be because maintaining directory accuracy is more complicated than it looks.
According to Chicago Sun Times, "Health plans contract with hundreds of thousands of providers and must hound them to send updates. Are they still with the same practice? At the same address? Accepting new patients?
For doctors and other practitioners, responding to such surveys - sometimes from dozens of health plans - is hardly at the top of their to-do list. Insurers typically offer multiple health plans, each with a different constellation of providers, who don't always know which ones they're in."
While there has been a surge in companies who collect provider data and offer to sell it to health plans, it appears that health plans and providers, "often have outdated data systems that don't communicate with each other."
Simon Haeder of Texas A&M University's School of Public Health says a significant improvement in health plan directories will require "more connectivity and interoperability."
Fortunately, solutions like VerityStream Network are coming to the market to deliver health plans the connectivity and interoperability needed.
We recently sat down with Anitha McNeilly, VerityStream Product Manager, to learn more about Network. She explained that, "Network is a VerityStream solution designed for health plans to support their need to credential and onboard practitioners within select networks. With Network, health plans get a one-stop shop for solving the unique challenges related to network management. This includes delivering provider network adequacy, directory accuracy, seamless provider onboarding, and compliance with industry regulations, like the No Surprises Act."
Network is a product that integrates with VerityStream's CredentialStream. CredentialStream includes everything you need to request, gather, and validate information about a provider to create a Source of Truth. Network taps into that data and allows health plans to manage and monitor a provider network.
Within Network, there are three easy to use tools that can help health plans achieve directory accuracy:
Notifications can be used to create an automated message every 90 days that reminds providers to verify their directory information.
Workflows can be used to create a simple checklist that includes a timeline that providers need to adhere to when reviewing their directory information and linked to notifications.
Surveys can be used to request providers to attest to the accuracy of their directory information.
According to McNeilly, "We know that industry regulations are only going to get tougher in the years ahead. New regulations will continue to roll out until directory accuracy is achieved and fines will be a reality for those that don't comply. Network is here to help health plans guarantee compliance."
Health plans that use Network by VerityStream can deliver directory accuracy and emerge a health plans of choice. Contact us to learn more.