Network directory errors remain an issue, AMA report finds
A new survey from the American Medical Association (AMA) and LexisNexis Risk Solutions found 52% of U.S. physicians say they see patients every month with health coverage issues related to inaccurate directories of in-network physicians.
The AMA said the survey results show that physicians and health plans must work together “to eliminate potential barriers to care when patients rely on outdated, inaccurate or incomplete directory data to locate an in-network physician.”
The survey found 67% of physicians would prefer a single, centralized interface to simultaneously update directory information for multiple health plans.
Nearly all of the 700 physicians surveyed (89%) said having accurate information in network directories is important. Having incorrect information could complicate getting care and could end up costing patients more if they unknowingly get care from a provider who is actually out-of-network.
This issue isn't only a private payer problem. A recent CMS report found 52% of provider locations for Medicare Advantage (MA) plans were inaccurate. That was the second CMS review on provider directories that found problems. The agency requested more oversight over the directories after finding out about the problems. The CMS also said MA organizations should perform self-audits of directory data, work with practices to ensure accuracy and develop better internal processes for members to report errors.
Though healthcare stakeholders agree that accurate provider directories are important, keeping them up to date can cause headaches and added work for providers. Laurie McGraw, senior vice president of AMA Health Solutions, said 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 AMA is working with LexisNexis on a project that centralizes provider data to meet state and federal directory mandates. The product, which is called VerifyHCP, allows physician practices to update the information for all participating health plans in one place.
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