Improving Provider Directory Accuracy

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Centers for Medicare and Medicaid Services (CMS) requires all Qualified Health Plan (QHP) issuers to provide updated provider directories every 30 days to its members.
With new rules around this required provider data refresh, many QHPs are rethinking their strategy. Many are working to understand how big of an issue it is for them and debating how best to approach a solution. This requirement exposes several possible issues including but not limited to data cleanliness, the need for updated business processes and improved member experience and costs. As we speak with payers, we are seeing several different ways in how they are dealing with these changes:

  1. Some have opted to provide an addendum to preprinted provider and pharmacy directories as a quick solution to the change. Therefore, when they receive a directory request from a member, a query will be executed in their database to see what provider/pharmacy information has changed. The delta is then printed as an addendum and added into the mailing with the preprinted provider or pharmacy directory. This method becomes labor intensive and offers an inferior experience to members.
  2. Others are deduping data monthly without standardized data cleansing processes.

These solutions have some immediate short term gains but ultimately create more complexity and inefficiency within the business over time. Particularly when managing several different programs. Rather, QHPs need an efficient process to provide frequently updated and accurate provider directories that does not significantly increase resources.
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Indellient’s Compliant Healthcare Directory Solutions (CHDS) was developed to efficiently address this kind of issue by understanding the challenges our clients and others have and then developing a solution that is configurable to each unique client environment.
The Compliant Healthcare Directory Solutions (CHDS) provides a streamlined method for offering members more accurate information that also significantly improves efficiency around directory update processes. For QHPs, it significantly lowers the barriers for meeting the kinds of compliance regulations noted above. Furthermore, this solution allows QHPs to offer directories that are tailored to each member’s locale for a better experience (geo-coding).
Learn more about Compliant Healthcare Directory Solutions here.


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Katie Hulan

Katie Hulan