No Surprises: Provider Data Accuracy Mandated

Provider directory accuracy is more important than ever. The No Surprises Act is going into effect in January 2022. This bill was passed to help prevent surprise billing and provider directories are directly related. As healthcare payers work to address payment and billing process changes, they could miss the new rules about directory accuracy.

The new regulation targets provider directories and requires that health plans:

• Update provider directory information at least every 90 days
• Remove unverified providers from the directory and make updates within 2 days of receipt
• Be responsible for out-of-network billing done through physicians listed on the directory as in-network

Currently, penalties for non-compliant health plans haven’t been determined, but that’s not the only motivation for making the accuracy of provider information a priority.

Inaccurate Provider Data Costs

Provider data is at the heart of operations and patient satisfaction. Inaccuracy in provider directories can lead to poor patient access, government sanctions, profit reductions and inefficient business operations. This can also lead to care gaps due to untimely communications between patient and physician. 

Our data indicates that on average 12% of provider locations listed are not current and accurate. We also find that 12.66% of provider records are of sanctioned providers. A patient wouldn’t be happy to drive to the wrong address for an appointment or to find out that their provider is sanctioned. Augmented and cleansed provider data lowers the compliance risks of inaccurate data, field calls and other targeting that can negatively impact your revenue.

Duplicate records create a data governance issue that requires resources to solve. Someone needs to determine which record to use and provider outreach may be necessary. Our data indicates that 14.56% of provider records have phone numbers that are outdated or not accurate, making outreach more time consuming.

Inaccurate data costs. Without a trusted data partner, the process to maintain accurate provider directories can be complex, daunting for already overburdened staff and costly to your organization. Prioritize provider data accuracy for cost savings and better health outcomes. Make it easy for patients to find the right care and care provider. Accurate provider information improves communication, creates operational efficiencies and enhances value-based care to improve health outcomes.