Are you doing everything you can to ensure that your provider directories are as accurate and up to date as they can be? On March 22, CMS released disappointing summary findings on payer compliance with federal requirements related to accuracy and online availability of provider data.

To assess the accuracy of provider data CMS used “secret shopper” calls and manually compared the online directory data, focusing on the accuracy of information related to location, contact, specialty, and availability to see new patients from 2017 to 2021.

Problems With the Basics

While there was marginal improvement noted over time, the results continue to show that health plans have a long way to go to meet both existing state and federal regulations, as well as new regulations laid out in the No Surprises Act. Among other observations, the report states that over five years, no more than 47 percent of provider records had current phone numbers, addresses, specialties, plan affiliations, and information on whether they were accepting new patients.

Validating From Source Authorities

ProviderLenz by Cúratus draws data from numerous public and private sources including from providers themselves as required in the ‘No Surprises Act’. This ensures that health plans are not only compliant with but are also gathering additional valuable information to ensure the most accurate directories.

Scoring Data Quality

ProviderLenz constantly monitors the accuracy of provider data, scoring each provider record in real time (24/7), ensuring that health plans know the quality of their data at ALL times. Cúratus guarantees that ProviderLenz will improve data accuracy or refund fees if minimum accuracy levels are not met and maintained.

Consolidated PDM Functions

In addition to curating and enriching provider data, ProviderLenz serves as a centralized master data management platform, ensuring that all provider data management elements of the ‘No Surprises Act’ are met with data updated immediately available in machine-readable format.

ProviderLenz performs a number of other health plan PDP functions as well including Network Adequacy monitoring and reporting, provider preclusion and sanction monitoring, IRS W9 Administration, direct bulk uploads by provider group partners, and much more.

Are You Ready?

Connect with us if you are interested in learning more about how ProviderLenz can help ensure that your provider data exceeds 90 percent accuracy.