Health plans are increasingly under pressure to maintain accurate provider directories, or they risk regulatory fines and potential third-party lawsuits. Given these regulatory and market pressures, healthcare providers are likely to see a lot more requests for up-to-date demographic data from your partner health plans.
Even though it takes time to update your information, there are benefits to ensuring directory data is accurate. Here are just five of those ways:
- It reduces the chance of claims being denied
In addition to coding problems, claims are sometimes denied because a piece of information submitted in the claim conflicts with data the health plan has on file. Something as simple as an address mismatch can be the difference between a claim that’s promptly paid and one that sits in limbo until the data issue is resolved.
- It helps patients who are right for your practice find you
Chances are you’ve had more than a few patients call to make an appointment, only to find out that your practice isn’t in-network, isn’t accepting new patients, or that the physician they wanted to see is not at your practice. It’s frustrating for not just for patients but for providers, who have to contend with no-shows or cancelled appointments. Accurate provider directories help patients find the providers who are right for them.
- It streamlines communication with the health plan
Health plan employees frequently call into the main line of a provider office looking for information related to claims or risk adjustment. These calls must often be transferred – sometimes more than once – which delays resolution of the issue and wastes the time of staff from both plans and providers. When health plans know who in the provider organization to contact for specific information, it can reduce unnecessary calls into the patient line.
- It simplifies referrals and authorization requests
Online referral and authorization forms rely on accurate information about your practice and the specialists to whom you refer patients. Forms that are prepopulated but require corrections waste your staff’s time and can introduce errors. Authorizations can also be denied when there’s a mismatch between the information you submit in the request and the payer’s information.
- It reduces administrative costs
The bottom line is that inaccurate and incomplete information drives up costs across the healthcare industry. Just as medical care is most effective when the physician has a complete picture of the patient’s information, administrative processes work most efficiently, and providers and health plans work together best, when all information is up to date.
How Availity can help you
One of the challenges you face getting accurate data to health plans is repeating the tedious, manual process for every payer you work with. Availity Provider Data Management (PDM) allows you to view, update, and attest to the accuracy of your information with multiple participating health plans all at once. Our user-tested workflows simplify data entry with downloadable templates, wizards, and pre-populated information based on information your payers and Availity already have about you.