AHIP launches initiative to improve accuracy of provider directories

Medical records

A new pilot project announced by America's Health Insurance Plans (AHIP) aims to improve the accuracy of provider directories that have been plagued by imprecise information, leading to confusion among consumers seeking in-network care.

Beginning in April, AHIP will launch a pilot project in three states using a primary contact for changes to provider practice data. For six months, 12 member plans in California, Indiana and Florida will participate in an initiative that allows providers to report changes or updates using a centralized approach rather than filing reports with multiple insurers. Two healthcare technology firms, BetterDoctor and Availity, will collect information from providers and disseminate updates to participating plans.

Increasingly, consumers use provider directories to select a physician or a healthcare facility that qualifies for in-network coverage. However, provider directories are frequently inaccurate and updating provider information is often convoluted and burdensome. Experts have estimated that even the most diligent approach to ensuring accuracy within provider directories yields a 20 percent to 25 percent error rate. In 2014, the Office of Inspector General determined that one-third of providers had an incorrect address in their plan's directory, and 50 percent were didn't offer appointments to Medicaid patients.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

For consumers, the process of identifying in-network providers can be "overwhelming," Susan Rider, a consultant with the insurance agency Gregory & Appel, told the Associated Press. Part of the confusion stems from inaccurate data collection, but many insurers also operate several different networks, each of which has its own directory of in-network providers.

"I think the biggest concern is really having consumers understand these networks," Florida insurance broker Wayne Sakamoto told the AP. "It's very confusing."

Beginning this year, Centers for Medicare & Medicaid Services can penalize insurers for errors in provider directories, including $25,000 per beneficiary for Medicare Advantage plan directories and $100 per beneficiary for plans offered through Healthcare.gov. In November, two major insurers in California were fined by the state for misleading consumers about physician networks.

For more:
- read the AHIP announcement
- here's the AP article

Suggested Articles

States want to try value-based payment models for drug costs, but there are plenty of barriers to implementation, according to a new report.

Oncology centers blasted a Trump administration proposal to bundle Medicare payments for radiation therapy.

At least six states are creating their own health insurance marketplaces or seriously considering doing so.