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By Sara Hansard
March 22 — Anthem, Cigna and Humana are among 12 health plans participating in a pilot program from April through September to make provider directories more accurate.
America's Health Insurance Plans (AHIP) announced March 22 it is sponsoring a pilot program through which more than 100,000 health-care providers in California, Indiana and Florida will have one point of contact to report changes in their practice information to all of the plans with which they contract.
Health plans have found it difficult to keep directories up to date as providers move and drop their association with plans, and regulators have singled out provider directory accuracy as an area that they want health insurers to improve. But providers, 20 percent of whom change practice locations every year, argue it is difficult for them to have to report changes to the multiple health plans with which they contract.
“This is a shared responsibility between health plans and providers and it requires a commitment from both sides to ensure consumers have the right information that they need,” AHIP President and Chief Executive Officer Marilyn Tavenner said in a press call.
“Given the sheer diversity of the providers participating in networks, small private practices, large provider groups, hospitals and more, there won't be a one-size-fits-all approach toward data coordination and reporting, but we do believe there are ways to improve the process that ensures greater accuracy and efficiency in reporting,” Tavenner said.
The goal of the pilot program is to find ways to make it easier for providers to report changes in their practices and to find ways for health plans to update provider data more quickly and efficiently, Tavenner said. At the end of the six-month pilot, AHIP expects to issue best practices for data reporting and accuracy, she said.
In addition to Anthem, Cigna and Humana, participants in the pilot project are Blue Shield of California, AvMed in Florida, Florida Blue, Health Net in California, LA Care in California, Molina Healthcare of California, SCAN Health Plan in California, WellCare in Florida and Western Health Advantage in California. The companies include commercial, Medicaid and Medicare Advantage plans and participation may grow during the pilot project.
Paul Markovich, president and CEO of Blue Shield of California who leads AHIP's task force on provider directories, said AHIP hopes to make the program national “once we figure out exactly what works.”
BetterDoctor, which validates information for 90,000 doctors a quarter and has helped 25 million people find doctors over the past five years, will work with plans in California and Indiana. Availity, a national health information network with more than 1 million providers and health plans and more than 500,000 daily users, will work with plans in Florida, where it has more than 95 percent of all providers on its network.
When anomalies in addresses or other information are identified, providers will be asked to verify their address, phone numbers and other contact information, specialties, whether a practice is accepting new patients, their insurance network status and hospital affiliations. The vendors will update information on their centralized databases, which will be shared with participating plans, and consumers will have access to the information as well.
New Medicare Advantage requirements for 2016 require quarterly outreach to providers to verify directory data, and California requires biannual validation of provider data. The pilot programs meet federal standards for qualified health plans participating in the federal Affordable Care Act HealthCare.gov marketplace, AHIP said. The Centers for Medicare & Medicaid Services “is well aware of this project,” Tavenner said.
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