Availity Blog

Availity Blog

Actionable insights for medical business professionals

The second problem CMS identified in its report on provider directories was a lack of internal audits by health plans to verify provider information. The report faulted health plans for outsourcing the audit process, stating “Medicare Advantage Organizations (MAOs) placed full faith in credentialing services and vendor support, and even in provider responses...” and “if MAOs had implemented routine oversight of their processes for data validation, errors in the provider directory would have become apparent.”

The RISE conference in Nashville was a great opportunity to learn about new approaches to analytics and member engagement, as well as to hear about many of the creative initiatives health plans are implementing to improve quality scores and meet the complex web of risk adjustment requirements for Medicare Advantage, ACA, and Medicaid.

CMS has identified three drivers of directory deficiencies: group vs. provider-level data, lack of internal audits, and reliance on provider-led notifications. We've outlined these issues in an infographic.

In its second annual report on the state of provider directories, the Centers for Medicare and Medicaid Services (CMS) found that 46 percent of all directory entries reviewed contained at least one error that makes it difficult for patients to find doctors in their networks.

Recently, three trends have aligned to signal highly favorable conditions in the independent radiology space for the coming year. These trends are: (i) a resurgence of the patient steerage debate; (ii) an increase in patient consumerism; and (iii) advances in pre-service technology that could significantly improve practice efficiency. Independent radiology centers that take steps now to prepare will be in an enviable position next year and better able to capitalize on these trends.

Your health plan has enough claims to process without adding ones that don’t belong to your organization. But that’s what happens when claims with invalid member or provider IDs enter your adjudication system. Internal resources can spend significant time working these before the error is discovered, which means higher staffing and administrative costs.

Availity understands that if you want to drive provider engagement, you need to find new ways to automate healthcare transactions. That’s why we are introducing two new automated workflows within our Provider Engagement Portal: appeals and overpayments.

In this edition of Availity Access, Mark Martin, product line director for provider data, discusses why addressing credentialing is the next logical step in Availity’s work to simplify data verification and improve the quality of provider data throughout the health care data ecosystem.

Working in healthcare guarantees you’ll be interrupted multiple times a day, whether it’s by staff, patients, physicians, or health plans. Fortunately, there are some tasks that can be completed on your timeline. Even better, when you get ahead of them you can greatly reduce the number of interruptions you face.

Availity recently commissioned an independent research company to survey providers—physicians and non-medical staff, in practices and facilities—about their credentialing process. No one should be surprised that providers are not happy with how it’s conducted.