5 ways to keep your provider directory accurate

by April Stiles...   
The value of accurate & compliant provider network data cannot be overstated. Provider Directories serve as road maps to help consumers and their families decide which health plan to enroll in or how to access the best care for their needs. According to a 2013 Health Reform Monitoring Survey, almost 56% of consumers consider a health plan’s provider network to be a very important factor when selecting a health insurance plan. 

Data accuracy is not only essential to assist consumer decision-making but it is also an important way for health plans & healthcare organizations to control costs & reduce network leakage. The cost is further compounded by fines from Centers for Medicare & Medicaid Services (CMS) and other government agency reaching as high as $25,000 per beneficiary for data errors.

So how do healthcare organizations manage the overwhelming amount of ever-changing provider information? 

Here are 5 ways to optimize your provider network data for better consumer experience & accuracy compliance.

1. ​Simplify the complexity of provider data
2. Create a single, authoritative source of provider information
3. Regularly check, score, & scrub your data
4. Enable real-time consumer support
5. Obtain consumer/member feedback

1. Simplify provider data management

In addition to consumers, provider network data is critical information necessary for team members throughout your organization. Disparities result from the use of spreadsheets, paper documents, & multiple technology systems. If one person makes an update to their spreadsheet, it may not get shared with colleagues across the organization. If everyone is working off their own data sources, the potential for manual errors, duplicates, outdated information, & other inaccuracies increases exponentially. Provider roster management becomes complicated & endless.

Outsourcing is the answer.

Provider directory data hosting & roster management can not only reduce workload, improve accuracy & lessen frustration, it can bring significant return on investment (ROI). By outsourcing provider data managment hosting to a trusted partner, health care organizations benefit from better data governance, more accurate payments to providers, reduced compliance risk, & happy consumers, members, & beneficiaries.
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2. Always access "authoritative" data

It is essential that provider directories reflect the most current & accurate information about participating providers & facilities so that individuals can maximize the value of their coverage, & better enable them to make informed healthcare decisions.

A master provider data index is the solution.

An effective index process is designed for ongoing lifecycle management of provider data. This data authority should check against its own provider information, as well as, third party sources.  The process design considers user needs, continuously checks correctness, enables accessibility, ensures availability & keeps data fresh.
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3. Know your provider data score

Provider data management is an ongoing process of collecting information, analyzing data, discussing with stakeholders, and sharing with partners & governing entities. It is essential to regularly update, correct, validate, & sync data. With data continuously fluctuating, it is difficult to know were to start.

​A data scorecard is a great, multi-tasking solution. 

1. The first step is knowing your provider data score. An intuitive data scoring solution analyzes your provider data to uncover duplicates, manual errors, outdated information, & more. It lets you visualize the opportunities for improvement.
2. Next it compares the data with a master provider data index & third party resources to scrub & validate your data.
3. For the final step, you can re-score your data & see how much your accuracy has increased.

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4. Chat with consumers

Choosing the right provider is a big decision for healthcare consumers. It can become overwhelming. Even with the most intuitively designed provider directory, they may still have questions & require guidance to make the best care decisions.

Why not add online chat capabilities to your provider directory?
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An AI-enable healthcare chat bot can help to guide customers through the selection process. This eliminates the need to have 24/7 staff coverage of online chat. With prepopulated & configurable Q&As, an automated chat solution can help to answer questions like:

1. "Is my primary care physician or specialist in the health plan’s network?"
2. "Which in network hospital is closest to where I live?"
3. "What type of doctor do I need?"

A friendly, intuitive online chat bot can help to reduce organization workload, & increase consumer confidence for a better experience with your organization.
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5. Get member/consumer feedback

​If a consumer or beneficiary has a bad experience due to inaccurate provider information or a negative provider interaction, it is important for you to know about it. Having to navigate through an automated phone system to find the right team member to address this only adds to their frustration. As you know, when a consumer has a unfortunate experience it reflects on your organization.

Solve this challenge by enabling provider rating & a directory feedback solution.

These two online solutions help to Increase customer engagement & gain provider insights. If a consumer has fresh information on changes with a provider or a negative experience, make information sharing easier. Feedback & provider ratings are a great way to enhance beneficiary and consumer communication & satisfaction.

Provider data management doesn't have to be daunting. Connect with the experts at Perspecta to understand how to improve your process. We'd love to hear from you.