Feds Issue the End of Inaccurate Provider Data

by Medversant Staff Writer

Posted on July 09, 2015

A federal investigation found that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed. A new regulation will require Medicare Advantage plans to update their provider directories with real-time data every three months, reflecting which physicians are in network and taking new patients. In a separate regulation, online directories for policies offered from healthcare.gov (the Health Insurance Exchange run by the federal government in 37 states) will be required to update provider directories monthly.

Inaccuracies found in the Medicare Advantage directories may be subject to penalties of up to $25,000 a day per beneficiary, or even bans on new enrollment. In addition, federal exchange plans could face fines of up to $100 per day for errors in their directories.

Broken Data in Healthcare

Some of the challenges that insurers face are that providers don't report if they have moved locations, retired, or changed their status with managed care organizations. These small inaccuracies result in a big challenge for any healthcare organization. There is a significant effort required to get providers to update their information and an even bigger challenge to manage the updated information. As soon as the health plan has collected updated provider information and it is entered into their system the data's accuracy has lost its validity.

The government has mandated data to be published accurately. The question is: are you and your organization ready? Medversant's ProviderIQ™ is patented technology that captures, verifies, and maintains provider data from disparate sources. Medversant's ProviderIQ™ guarantees the most efficient and accurate provider directory on the market.

Give us a call for more information about how ProviderIQ™ can help ensure that your provider data is accurate 213.291.6139.

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