Provider information changes all the time, and if you’re not keeping up with those changes, you could miss out and be at risk of non-compliance.
With 20% of providers shaking things up each year, changes can easily slip through the cracks. This often leads to inflated provider networks and inaccurate provider directories. Which we all agree is less than ideal, right? That’s why today, we’re diving into the exciting world of tracking and measuring provider data. We’ll show you why keeping up with the changes, having a responsive plan, and staying on top of network trends are vital to your success and compliance.
The Importance of Accurate Provider Data Management
The Trouble with Inaccurate Provider Networks and Directories
Picture this: You’re working with provider networks and databases, relying on data that you believe to be accurate, only to realize that half of the information is outdated or incorrect. It’s a nightmare scenario, and it can have serious consequences for both insurers and the insured.
For insurers, inaccurate provider networks and directories can result in:
- Non-Compliance Issues
- Decreases in Member Retention
- Negative Quality Rankings
- Civil Monetary Penalties
- Termination of Program Contracts Such as Medicare Advantage, Medicaid, or Qualified Health Plan
- Sanctions for Non-Compliance
- Negative Media Coverage
- Suspension of Enrollment
For insured, inaccurate provider networks and directories can lead to:
- Wasted Time
- Missed Appointments
- Delays in Treatment
- Health Conditions Continue to Progress
- Receive Care From an Out-of-Network Provider Without Knowing It – Sidenote for health plans – this one could lead to a new level of arbitration for you.
The Power of Data Analytics in Provider Data Management
Provider networks are constantly changing, with mergers, additions, and providers coming and going. To ensure compliance and success, it’s essential to have an easy way to track these changes and understand their impact. By embracing data analytics in provider data management, you open doors to opportunities and possibilities that can greatly benefit your organization. Here’s what you can achieve:
Identify changes, opportunities, and risks: Stay informed about any changes within your data. Uncover hidden opportunities and potential risks that can impact your networks.
Keep your networks up to date: Track provider data changes immediately to ensure your networks are always current. Minimize disruptions and seamlessly manage transitions.
Evaluate accuracy and adequacy: Assess provider network accuracy and adequacy to make sure they are operating optimally and meeting your needs.
Manage for success: With active tracking, you can proactively manage your networks to achieve your goals. Make data-driven decisions and take targeted actions to ensure performance measures are met.
Regular Data Analysis for improved provider data management
You’ve probably heard the saying, “If you can’t measure it, you can’t improve it.” The same holds true for provider data management. By incorporating regular data analysis into your processes, you can track your progress and gain valuable insights into crucial areas. Here are some key benefits.
Provider Changes: Detect any decline in providers in specific areas, allowing you to take proactive measures to address the situation.
Network Adequacy and Accuracy: Compare network adequacy and accuracy of your networks across different product lines by analyzing data over specific time periods like quarter-over-quarter.
Target Performance Management: Successfully manage your networks to meet target performance on key measures that drive exceptional healthcare outcomes.
Regular analysis not only provides valuable insights into network trends but also empowers you to create a more responsive and well-designed network that meets regulatory requirements.
Best Practices: Measuring Results through Daily Tracking and Evaluation
Now that you understand the benefits of tracking provider changes, it’s time to act! Here are three tips to help you respond promptly and efficiently while remaining compliant and improving data accuracy every step of the way.
Tip #1: Let Automation Be Your Ally
Say goodbye to manual data management and hello to sophisticated tools that work for you 24/7. Automation is the game-changer you’ve been waiting for when it comes to tracking provider changes. By letting technology take on the heavy lifting, you can focus on other pressing tasks, secure in the knowledge that your data is accurate and up-to-date.
Tip #2: Establish Clear Communication Channels
Creating clear and convenient communication channels with your providers is critical to receiving timely data updates. Let Quest Enterprise Services Accuracy work with providers on handling updates, and in turn, show you what has changed. By streamlining provider outreach and verification, you can see changes and make adjustments quickly.
Tip #3: Regularly Review and Analyze Data
Don’t fall into the trap of set it and forget it. Regularly review and assess your provider networks for compliance with regulatory guidelines, ensuring that you meet all necessary criteria and stay in good standing with regulatory authorities.
By reviewing your data regularly, you can identify areas for improvement and drive positive change in your provider data management processes.
Ready to Optimize Your Provider Data Management?
Ready to optimize your provider data management? Contact us today to learn how our advanced tools and solutions can streamline your processes, achieve compliance, and drive value in your provider networks.
More On Provider Data Accuracy and Network Adequacy
Stay up-to-date on the latest developments and best practices in provider data accuracy with these valuable resources! We’ve rounded up some of the most helpful articles on current network adequacy and provider data accuracy rules to help you navigate the changing landscape. Dive in now!
Proven Solutions for Your Provider Network Management
Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid and Commercial. Schedule a strategy session today and see how we can help you every step of the way.
