- The implementation of the ACA has sparked greater scrutiny of health plan provider directories, with backlash occurring against those considered inaccurate or misleading.
- Payers face numerous factors that are increasingly impacting their ability to maintain accurate directories, according to Berkeley Research Group (BRG), including limited resources for directory maintenance, increasing complexity of products being offered, and the dynamic nature of participating provider information.
- As litigation and penalties become more prevalent, payers will start taking these risks more seriously, the study author says.
To sum up the research, health plans should now be taking a proactive role in achieving and maintaining provider directory accuracy, even if they have to overcome operational challenges to do so.
"Given an environment that is increasingly regulatory, litigious, investigative, and putative, health plans should deploy organizational resources at a level that is commensurate with the level of risk that these inaccuracies can present,” Brian Hoyt, Managing Director at BRG, told RevCycleIntelligence.
The Centers for Medicare & Medicaid Services (CMS) has warned that it may issue penalties and enrollment sanctions against health plans with inaccurate or deficient directories, and has already levied a million dollar fine against Aetna for inaccuracies in provider information disseminated through one of its call centers, according to Hoyt. As for the risk of litigation, Hoyt notes that California currently has nearly a dozen lawsuits against health plans regarding alleged inaccuracies of provider directories.
To ensure that accurate and timely information is received from providers, Hoyt predicts that health plans will begin to find ways to put them on the hook during contract renewals and negotiations.