A couple of weeks ago we shared information on LinkedIn about the implications of the ‘No Surprises Act’ on health plans. With the new law going into effect in January, it is more critical than ever for health plans to have tools in place to manage their provider data.

A multi-pronged approach to provider engagement along with flexible technology to make near real-time directory updates are essential. ProviderLenz addresses each of the critical components needed to ensure compliance related to the provider data management elements of the law.

Key Points For Payers

• The law goes into effect January 1, 2022.
• Payers must outreach to ALL providers to verify and update directory information at least quarterly.
• Payers to create a procedure for removal of providers for which they are unable to verify information.
• Payers must update their directory within 2 days of receiving new information about a provider.

Outreach to All Providers At Least Quarterly

The logistical challenges alone are daunting: How to manage outreach flow? What is/are the most effective method(s) to reach the provider? How to track each outreach attempt to every provider AND every response (or lack of response)? These are some of the many questions that have been addressed in the design of the automated Provider Data Validation process in ProviderLenz.

There is no ‘one size fits all’ approach to which method provider offices can or will respond. This is why ProviderLenz employs multiple outreach methods as well as artificial intelligence to track what providers are responding to and when to guide future engagements with those providers. Initial engagement campaigns include e-mail, e-fax, and telephonic outreach, which are all fully automated and sequenced by Providerlenz as depicted below to track and ensure optimal response rates in contacting and updating provider information.

Removal of Providers for Which Information Verification is Unsuccessful

ProviderLenz is designed to allow maximum flexibility of data access and updating while ensuring that no historical data is ever lost, overwritten, or deleted. The platform allows for routine (real-time) activation and deactivation of a provider record to ensure continual compliance with provider preclusion, Surprise Billing, and all other applicable rules and regulations. This functionality is administered seamlessly within ProviderLenz which in turn continuously updates client IT systems via API. This feature minimizes payer exposure to out-of-network claim liability by ensuring continuous provider data accuracy.

Payers Must Update Their Directory Within Two Days of Receiving New Provider Information

Two days does not give a lot of time for systems and processes to identify and act on updated information. As a true Master Provider Index, ProviderLenz constantly updates all of a health plan’s core IT systems that rely on accurate provider data. Those same updates can also be provided to any external systems that use a health plan’s provider data.

Are You Ready?

No doubt the new law will challenge health plans’ processes and systems in place today to manage provider data not only for accurate directories, but for all other administrative purposes. If you are interested in learning more about ProviderLenz and how we can help improve your provider data management, please contact us.