Physicians, Health Plans Must Collab for Network Directory Accuracy
A More Centralized and Streamlined Solution to Reduce Directory Errors Can Help Increase Transparency for Patients
CHICAGO - According to a survey released today by the American Medical Association (AMA) and LexisNexis® Risk Solutions, more than half of U.S. physicians (52 percent) say they encounter patients every month with health insurance coverage issues due to inaccurate directories of in-network physicians. The survey findings illustrate a need for physicians and health plans to work together to help eliminate potential barriers to care when patients rely on outdated, inaccurate or incomplete directory data to locate an in-network physician.
The new findings, which examined the experiences of roughly 700 U.S. physicians, underscore that network directories are a critical tool for patients when making decisions about their health care. The vast majority of physicians (89 percent) say it is important to be accurately represented in network directories. Patients who make decisions based on inaccurate directories risk incurring unnecessary costs when they thought they were using an in-network physician.
The new survey comes on the heels of a federal audit of network directories published by Medicare Advantage plans, which found that 52 percent of the provider locations listed had at least one inaccuracy. As a result, the federal officials issued 23 notices of noncompliance and 31 warning letters this year to Medicare Advantage plans.
“Recognizing the importance to patients of high quality directories, federal and state governments have created regulations requiring health plans to increase the frequency of physician data verification,” said Laurie McGraw, senior vice president of AMA Health Solutions. “As a consequence, some physician offices have experienced an increase in repetitious data verification requests from health plans that are mandated to constantly ensure the quality of network directories.”
The duplication and complexity of data collection has left some physicians inconvenienced by an administrative burden. Yet most physicians (79 percent) are unaware that health plans are responding to mandates that require regular data verification. In fact, about two-thirds of physicians (67 percent) would prefer a single, centralized interface that can simultaneously update directory information with multiple health plans.
“Ensuring the accuracy of network directories needs to be a truly collaborative process for physicians and health plans,” said McGraw. “Physicians want patients to make informed health care choices, while health plans seek to comply with mandates to publish the most up-to-date network directories.”
The survey of physicians was released by the AMA and LexisNexis as part of a collaboration that offers physicians and health plans a centralized solution, VerifyHCP ™, which delivers data to facilitate meeting state and federal directory mandates.
Jointly launched in March 2017, VerifyHCP is powered by the physician resources of the AMA and its wholly-owned subsidiary AMA Business Solutions, along with LexisNexis analytic technology and the LexisNexis® Provider Data MasterFile™ to enable simpler and more efficient data confirmation to help create more accurate network directories and most importantly, supports the needs of patients, physicians and health plans.
“We knew there had to be a better, more efficient way for physicians and their office managers to simultaneously update practice details for multiple health plans,” said Josh Schoeller, vice president, Client Engagement, LexisNexis Risk Solutions. “The solution was in the data. LexisNexis houses one of the most comprehensive provider databases and, in combination with the AMA’s extensive relationships with physicians and practices, we developed a solution that 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.”
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 one 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.
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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 the LexisNexis Risk Solutions website.
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.
Robert J. Mills
American Medical Association
Office: (312) 464-5970
Email: [email protected]
LexisNexis Risk Solutions
Office: (843) 290-9408
Email: [email protected]
Summary of Survey Results
- About half of physicians (52 percent) say at least once per month their patients encounter health insurance coverage issues due to inaccurate information included in network directories.
- A large majority of physicians (89 percent) say it is important to be accurately represented in network directories.
- Most physicians (73 percent) are not aware of mandates related to the accuracy of network directories.
- About two‐thirds (68 percent) do provide information updates to payers, and they do so mainly via fax (38 percent).
- Most (67 percent) express interest in having their practice use just one interface to update and send network directory information to payers.
A total of 703 physicians were surveyed to assess their experience with network directories. The online survey was conducted between December 2017 and January 2018. The survey sample was comprised of patient care physicians in the United States who are not residents or fellows.