Accurate provider information is essential for access to healthcare

Consumers with health insurance, both independent and employer sponsored, rely on insurers’ provider directories to make choices about their plans and find physicians that are right for them. Directories include vital information such as essential contact details, distance from public transportation, accessibility for individuals with disabilities, languages spoken by practitioners and staff members, and more.

According to the Centers for Medicare & Medicaid Services (CMS), provider directories that have wrong contact information, or incorrectly show whether a doctor is in network, are a huge barrier to care. But errors in provider directories are one symptom of a larger problem: payers still rely on outdated contracting and credentialing processes to get updates from their network of providers. Consolidation, acquisitions, and other factors are increasing physician churn, which means provider directory information is changing faster than ever. Businesses that provide care must have a better way to update their payers when information changes.

So far in 2018, more than 200,000 healthcare provider organizations—representing over 500,000 physicians and 20,000 facilities—have updated and/or verified their provider directory information using the provider data management app on the Availity Provider Portal. Those updates have improved the accuracy of one payer’s directory entries from 56% to 80%.

Providers have made more than a million corrections to their information: that shows a lot of promise for an introductory service, but as an industry there is still a long way to go. Availity is driving innovation and results by comparing information in provider profiles with transactional data and presenting suggested updates to providers. This allows providers to quickly focus on resolving the most important issues in their record.

Networks like Availity must work with providers, payers, and industry organizations like WEDI and X12 to continue to drive standards into the process. As these standards evolve, payers will find it easier to integrate updates into all their data systems, reducing costs and improving efficiencies for all stakeholders in processes from credentialing through risk management and claims processing.