Provider Directory Management: Enhance Member Confidence and Loyalty

An inaccurate healthcare provider directory can have serious consequences for Patients, Health Plans, and Providers. Maintaining accurate and easily accessible provider directories is extremely difficult for Health Plans because of the complex nature of the healthcare industry and the fluid nature of the participating providers’ information. Prime’s comprehensive provider directory management solutions help you eliminate inconsistencies in the provider data, improve data quality and meet strict federal and state regulations thereby avoiding expensive penalties. With easy access to the right in-network provider information, patients are empowered to make smart decisions for their healthcare.

Significance of Provider Directory Management

Provider Directory ManagementA Health Plan Provider Directory helps members search, compare, and select the right in-network providers and estimate their out of pocket costs for a visit or treatment.  An accurate healthcare provider directory empowers consumers with smarter choices and:

  • Helps reduce the load of inquiries.
  • Eliminates frustration and builds loyalty to the plan.
  • Makes it easy to connect with providers.
  • Makes it easy to produce the directories in a print-ready format.
  • Reduces the possibility of audits and penalties.
  • Enhances member confidence in their healthcare decisions.

Health Plans accustomed to using quick fixes to update their provider directories are facing a new and expensive reality. Fines for inaccurate information can now be as high as $25,000 per day per beneficiary and payers who are found in violation of Centers for Medicare & Medicaid Services (CMS) rules can be banned from new enrollment or marketing.

A 2017-2018 CMS healthcare provider directory review found that nearly 49% of directories contained inaccurate information. Common errors in healthcare directories include:

  • Incorrect telephone numbers and location information, which can limit access to care.
  • Lack of standard definitions.
  • Mislabeling provider participation status can result in out-of-pocket bills for patients and caregivers.

PRIME’s Healthcare Provider Directory Solutions

PRIME’s healthcare provider directory solution helps simplify the process of capturing, storing, and retrieving provider data. Where most companies rely on updates from the providers themselves, our provider directory service uses an innovative direct contact approach. Multi-point, multi-contact methodologies are used to survey providers, helping to eliminate false positives while improving quality and data integrity.

Consumers want accurate information about the providers in their networks and healthcare providers want a simpler way to share this information with health plans. PRIME improves the quality of your organization’s provider directory by streamlining the data collection and evaluation process.

If you’re looking for a way to maintain accurate provider directories thereby improving the ability for members to make more informed healthcare decisions, PRIME’s solutions offer the highest-quality provider directory data services in the industry at a reduced total cost of ownership compared to the other solutions.

To learn more about how PRIME’s healthcare provider directory management solutions can help your organization provide accurate, up-to-date provider data, contact us today.