Inaccurate provider data raises the financial stakes for health plans
Public outcry over inaccurate provider directories has prompted the government to take action, and your health plan faces steep regulatory fines as the result of bad data. There’s also the increasing threat of lawsuits from consumers who have been charged out-of-network fees for visits they believed were in-network. The challenge for health plans is that provider data changes constantly and there are few good ways for to capture these changes when they happen.
Today, health plans rely on manual data capture. Every time there’s a demographic change, providers are expected to fill out and submit a form to each contracted plan. It’s a time-consuming process made more so by the lack of data consistency among health plans.
Availity understands that you are more likely to capture data from providers when it’s easy for them to send it to you. That’s why our health plan solutions focus on engaging providers within their workflow, helping you gather and maintain the most up-to-date information.