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LexisNexis® Risk Solutions Solves for Critical Provider Data Inaccuracies Cited in CMS Directory Audit

VerifyHCP® provides a central solution for validated provider data at the plan level

12/13/2018

ATLANTA — According to a recent CMS Online Provider Directory Review Report, provider directory accuracy has not improved since its first review published in early 2017. The most common driver of errors is the reporting inaccurately at the group level rather than the provider level. This and other problem areas outlined, can be solved with VerifyHCP® – a robust central repository of provider information that streamlines and automates ongoing management and maintenance of provider data integrity.

The CMS report summarized audit results of its Medicare Advantage Organizations (MAOs) including 52 MAOs, 108 providers per MAO for a total of 5,602 providers across 10,504 locations.  Common deficiencies included:

  • provider should not be listed in directory at that location (39.61% of all deficiencies)
  • provider should not be listed in directory at any of the directory indicated locations (26.43%)
  • wrong phone number (13.09%)
  • wrong address (6.91%)
  • wrong suite (4.53%)
  • provider is accepting new patients (4.46%)
  • provider is not accepting new patients (4.19%)
  • wrong specialty (0.46%)
  • provider name needs updating (0.32%)

“Reconciling, vetting, managing and maintaining quality provider data is a daunting task and the recent CMS results validate that,” said Josh Schoeller, senior vice president and General Manager of LexisNexis Risk Solutions, Health Care. “VerifyHCP® is a multi-faceted data validation solution that serves as a central repository and distribution hub, a critical component to solving the directory accuracy problem as highlighted in the report. It deploys claims analytics and ongoing data enrichment services to ensure the data contained within remains a source of truth for the health plans leveraging it,” he added. 

LexisNexis VerifyHCP® is built on one of the most comprehensive provider databases in the industry. It uses a single sign-on and has the ability to pre-fill, collect, monitor, cleanse and update data in an easy-to-use, efficient manner. Customers are realizing improvements in the quality of their provider data as a result of this approach.

VerifyHCP® makes it unnecessary for health plans to send physicians duplicative data verification requests, relieving physicians of the distraction from a barrage of uncoordinated requests from multiple health plans. VerifyHCP® enables medical practices to validate or update directory information through a pre-fill channel for all participating health plans.

VerifyHCP® is a uniquely flexible solution to update practice details for multiple health plans, reducing costly administrative tasks for medical practices and health plans. At the same time, it streamlines compliance with network directory accuracy requirements for health plans and helps ensure patients know which of their physicians participate in their current health plans.

For additional information, please visit the LexisNexis website.


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.

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