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Want to reduce paper communication between health plans and providers? You need to improve provider data accuracy.


3.23.2020 By Availity


Nineteen million. That’s the number of pages of documentation one health system receives each year from health plans, according to a revenue cycle executive who spoke last month at Availity Connects: 2020 Summit.   


Availity Connects, our annual conference in Amelia Island, Florida, brings together representatives from health plans and provider organizations to discuss ways to solve the healthcare industry’s biggest challenges. One of this year’s key topics was the burden of paper on health plans and providers, and attendees discussed many potential solutions, which ranged from fully implementing electronic attachments to leveraging artificial intelligence. But provider representatives also had another, seemingly simple, request for their health plans partners: 


“We understand you have complex systems, and we can’t expect you to change overnight and completely stop sending mail. But if you could just send the mail to the right address, that would be a huge improvement.”


It’s a provider data problem

Unfortunately, it’s not easy for a health plan to update provider addresses across the entire enterprise. Just like it’s not easy for health plans to keep provider directories up to date. In fact, these issues are both symptoms of the same, systemic problem, which is that health plans don’t have a good way to update and maintain accurate provider information. 

Availity has been sounding the alarm about provider data accuracy since 2015, even before CMS first began tightening federal laws around provider directory accuracy. But the challenge has been getting stakeholders to recognize that the problem isn’t the directories themselves, but the underlying provider data which populates them. In a 2018 blog series, we touched on the three issues at the core of the matter: contractual versus resource constraints, the lack of internal audits, and the need for better provider engagement.

The wrong approach to a provider engagement strategy

In the last few years, health plans have started partnering with vendors on a better provider engagement strategy, which includes asking provider administrative staff to verify demographic and other relevant information. While this is the right approach, many of these solutions won’t overcome two core limitations: 


They force administrative staff out of their workflow: Provider organizations are trying to minimize administrative complexity by reducing the number of tools their administrative staff has to use. But many provider directory solutions are single-purpose tools that exist outside of the administrative workflow. Because these tools are only used occasionally, administrative staff will need regular retraining on the functionality, which will make it much harder for health plans to drive adoption among their provider networks.

They don’t target the appropriate staff members: Provider information must be vetted by staff members who both understand the context of the information and are authorized to make changes to records. Typically, this is the practice manager, credentials manager, or other senior-level administrative staff. But with high administrative turnover, it’s not easy to identify or keep track of the correct contacts within a provider organization. Many solutions address this by blasting emails or faxes to whatever information is on file. Often, these requests are ignored—either because they are never received or because the recipient doesn’t know what to do with them.    

Lessons learned

Since Availity launched our Provider Data Management (PDM) solution in 2016, we have learned a lot about what it takes to get provider organizations to take action and update provider records. And we’ve seen good results. Health plans that use Availity PDM have seen their directory accuracy ratings improve from 44% to 82%. The biggest takeaway: it’s easier to get provider organizations to attest to data if they are notified—and able to respond to the notification—within their workflow. 

Learn more about Availity’s Provider Data Management solution at /provider-data-management


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