- Medical practices spend $2.76 billion annually updating information in a multitude of provider directories — or an average $998.84 per month, per practice, according to a new whitepaper from CAQH. The alliance of health plans including Anthem, UnitedHealth and others creates electronic processes to streamline common administrative tasks.
- By updating information using a single data interface, medical practices would save at least $1.1 billion annually — or $4,746 per medical practice, the group said.
- The cost of directory updates varies by region. The Northeast had the highest per-practice, per-month cost ($1,245.60), followed by the South ($976.51), Midwest ($931.16) and West ($808.18), according to the report.
Errors in network directories cause problems for providers, payers and patients. Without accurate information, consumers may accidentally choose a provider who is out of their insurer's network, leading to surprise medical bills, where patients are charged for out-of-network costs that they don't anticipate. Without accurate information, consumers may not realize that providers have moved to a new location, changed phone numbers or are not accepting new patients.
CAQH found that medical practices send updated directory information for an average of 20 insurance contracts with different schedules, technologies and formats.
The amount the medical practices spend on directory updates each month varies based on the number of contracts — from a low of $428.02 for fewer than 10 contracts to a peak cost of $1,606.20 for more than 31 contracts.
Updating provider directories is not only expensive but error-prone. A CMS report in 2018 found that 52% of provider locations in directories for Medicare Advantage plans were inaccurate. And a 2018 report from the American Medical Association and LexisNexis Risk Solutions found that more than half of doctors report seeing patients each month with insurance coverage issues related to inaccurate directories.
Given the expense and inaccuracies involved in maintaining provider directories, a group of healthcare companies last year launched the Synaptic Health Alliance to test a blockchain-enabled process to update providers' demographic information.
The companies involved in the pilot include CVS Health, Ascension, Humana, UnitedHealthcare, UnitedHealth Group's Optum, MultiPlan and Quest Diagnostics.
In a similar vein, CAQH and the Provider Data Action Alliance released a roadmap last year to guide development and implementation of a single solution.
To arrive at the dollar amounts for the new whitepaper, CAQH collected survey responses from 1,240 physicians last month. The organization projected savings from using a single database to update provider directories based on the costs associated with CAQH ProView, a provider credentialing database.