ATLANTA and CHICAGO – LexisNexis® Risk Solutions and the American Medical Association (AMA) have launched the Verify Health Care Portal, the clinician attestation component of VerifyHCP®, a robust solution for monitoring physician information that simplifies a successful data strategy for managing a health plan network. The Verify Health Care Portal uses payer directory information and combines it with LexisNexis Health Care’s database of healthcare professionals and its linking technology to pre-populate the portal with updated information on health care professionals to enable simpler and efficient attestation. As a result, health plans are able to present patients with more accurate directories of available health care professionals.
VerifyHCP® is the only solution to take a payer consortium approach that leverages the power of the LexisNexis HPCC Systems® computing platform and proprietary linking algorithms and the AMA’s reach and engagement with physicians and practices to centralize and streamline the process of managing network directory accuracy.
Consumers depend on physician directories to access care. Publishing inaccurate information via directories poses a risk that patients may visit a physician who is not in network, potentially incurring thousands of dollars in unnecessary costs. State and federal regulations require health insurance plans to present patients with up-to-date network directories of available health care professionals. Many states have regulations that require regular data verification from clinicians to ensure accurate network directories. At the federal level, Medicare Advantage Plans, Qualified Health Plans and certain dental plans require quarterly outreach to health care professionals. In many states, Medicaid must conduct regular outreach on a monthly, quarterly or annual basis, and federal rules require Medicaid managed care organizations to update directories monthly.
The Verify Health Care Portal component allows clinicians to focus their time on patient care vs. administrative tasks by seamlessly fitting into existing office workflows to enable physicians and their office managers to update practice details for multiple health plans with a single sign-on, reducing the burden of non-clinical tasks. At the same time, it streamlines compliance with network directory accuracy requirements for payers and helps ensure patients know which of their physicians participate in their current health plans.
The power of VerifyHCP® lies in its ability to pre-fill, collect, monitor, cleanse and update data in real-time. It also incorporates a multi-channel outreach campaign using email, fax, call and direct mail per the applicable regulatory guidelines. Enhanced flexibility of the solution is another benefit: It supports federal and state legislation requirements; the attestation needs of provider organizational structures and associations; has the ability to attest at the provider network level; and allows for office manager and group attestation.
The Verify Health Care Portal is powered by the physician resources of the AMA and its wholly-owned subsidiary AMA Business Solutions, and LexisNexis Health Care’s analytic technology, VerifyHCP® and the LexisNexis® Provider Data MasterFile™. Among the nation’s most comprehensive databases of provider information, Provider Data MasterFile draws on more than 2,000 sources to build a powerful view of a clinician and covers more than 8.5 million health care professionals. The application leverages LexisNexis Health Care’s proven mastery in managing large volumes of data from thousands of sources and health care expertise to understand how and where this information is needed by consumers and health plans.
In November 2016, LexisNexis Health Care and the AMA agreed to collaborate to offer the Verify Health Care Portal.
We recently sat down with Laurie McGraw, Senior Vice President of Health Solutions, AMA and Lee Rivas, CEO, Public Sector and Health Care, LexisNexis Risk Solutions & President, Elsevier Health to discuss the ramifications of the Verify Health Care Portal.
LexisNexis Health Care – Why are LexisNexis Health Care and the AMA working together on the Verify Health Care Portal?
McGraw: As the largest professional membership organization representing physicians, the AMA is striving to reduce administrative burden so physicians can spend more time doing what they love: helping patients. Physicians have helped us to understand their unique needs and challenges and how the AMA can best meet them. For physicians and their practice staff, being able to verify or update their practice data in an easy and seamless way is a step in the right direction. It was important that the AMA partner with an organization that had a demonstrated commitment to easing the administrative burden placed on physicians and their practice staff. With its robust data assets and technology capabilities, LexisNexis Health Care had a deep foot print in the payer industry as well as the desire and ability to create a single solution to address federal and state directory regulations.
Rivas: Inaccurate provider directory data is at its heart a problem for patients. Solving this problem requires payers and physicians to work together to deliver accurate and timely data. We sought to work with the AMA because we knew that our combined resources positioned us to build a solution that could help meet the need of everyone involved – payers, physicians and patients – better than anyone else in the market.
LexisNexis Health Care – How does this collaborative effort create an end-to-end solution for physicians, payers and patients?
McGraw: Creating accurate directories is truly a collaborative process. Physicians have their information and expect to be represented accurately, while payers are required by key mandates to publish the most up-to-date network directories. The collaborative process is challenged as physicians may be asked to enter redundant data through payer-specific proprietary formats on inconsistent timelines. Since a medical practice have an average of 12 managed care contracts maintaining this information can be a time consuming and onerous task. The Verify Health Care Portal allows physicians to attest once, delivering the updated, accurate data across all participating plans, giving patients the reliable information they need to make informed decisions when selecting the right health plan, or finding an appropriate physician. The AMA’s goal is to help physicians succeed in their life’s work of caring for patients, which is why we are always striving to offer timely, relevant tools like this one to provide the support they need when they need it.
Rivas: Patients have a right to expect that their health plan’s physician and clinician data will be accurate when they consult the directory, and health plans definitely want to be in compliance. But, physician information is always changing. For example, if a physician’s information is correct today, we’ve found through our own research that after 18 months, almost 15 percent of the records would contain errors or omissions. The Verify Health Care Portal streamlines the attestation process for physicians, so they can focus on treating patients instead of the administrative task of keeping directory data current. This data is timely and accurate helping to ensure health plans comply with the law. Most importantly, the patient wins because the physician data is accurate.
LexisNexis Health Care – Why should physicians use the Verify Health Care Portal?
McGraw: The Verify Health Care Portal provides a friendly, intuitive interface where physicians or practice staff update directory data once, for all of their participating health plans.
Rivas: The Verify Health Care Portal virtually eliminates the physician’s attestation burden. Once a clinician attests to the directory data, he or she is not required to do anything further. The VerifyHCP® solution will update the directory information as changes occur on behalf of the physician.
To download the “The State of Provider Directory Accuracy” infographic, visit http://www.lexisnexis.com/risk/insights/state-of-provider-directory-accuracy-infographic.aspx.
About the American Medical Association
The American Medical Association is the premier national organization providing timely, essential resources to empower physicians, residents and medical students to succeed at every phase of their medical lives. Physicians have entrusted the AMA to advance the art and science of medicine and the betterment of public health on behalf of patients for more than 170 years. For more information, visit ama-assn.org.
About AMA Business Solutions
AMA Business Solutions is committed to addressing the most pressing health care industry needs through innovative data solutions, products, and services. Leveraging industry leading data assets, AMA Business Solutions strives to create or collaborate to deliver products that improve the efficient delivery of health care, reduce administrative burden, and improve the health of the nation.
AMA Business Solutions is a wholly-owned subsidiary of the American Medical Association.
About LexisNexis Risk Solutions
At LexisNexis Risk Solutions, we believe in the power of data and advanced analytics for better risk management. With over 40 years of expertise, we are the trusted data analytics provider for organizations seeking actionable insights to manage risks and improve results while upholding the highest standards for security and privacy. Headquartered in metro Atlanta, LexisNexis Risk Solutions serves customers in more than 100 countries and is part of RELX Group plc, a world-leading provider of information and analytics for professional and business customers across industries. For more information, please visit www.lexisnexis.com/risk.
Our health care solutions combine proprietary analytics, science and technology with the industry’s leading sources of provider, member, claims and public records information to improve cost savings, health outcomes, data quality, compliance and exposure to fraud, waste and abuse.
About LexisNexis Risk Solutions
LexisNexis Risk Solutions harnesses the power of data and advanced analytics to provide insights that help businesses and governmental entities reduce risk and improve decisions to benefit people around the globe. We provide data and technology solutions for a wide range of industries including insurance, financial services, healthcare and government. Headquartered in metro Atlanta, Georgia, we have offices throughout the world and are part of RELX (LSE: REL/NYSE: RELX), a global provider of information and analytics for professional and business customers across industries. For more information, please visit www.risk.lexisnexis.com and www.relx.com.