GHOST NETWORKS IN HEALTHCARE: WHAT ARE THEY?
Ghost networks is a term used by the healthcare industry to describe insurance directories that are filled with providers who are not clinically active in their indicated specialty or are not accepting patients. This inaccurate or out-of-date information in the directory can cause problems for patients, physicians and those managing a provider network.
Watch the video below to learn more about how we define ghost networks.
HEALTHCARE GHOST NETWORKS EXPLAINED
“Insurance companies populate their directories with whom they assume are clinically active and treating patients based off of their relationships with the Provider community. However, as we’ve progressed since 2020, providers have relocated – have changed where they’re seeing patients.
We’ve seen as you know, an incredible uptick in telehealth providers and fewer providers in brick-and-mortar locations. Those insurance directories relying on kind of just the traditional paper contracts that have existed, for where providers might be clinically active, are no longer meeting the needs of the ecosystem.
And that’s created this phenomenon of those providers or those networks that we’re getting to hear quite a bit about.
So, you might hear the term ghost provider or phantom networks. As a kind of data guy at heart, it’s really created by any inaccurate or outdated provider data. Generally, not an intentional misrepresentation of a provider network.
But, the result of relying on information, that as the dynamics change within the market – and it can change on a daily basis – is becoming outdated. And, as an industry ecosystem, we need to begin to move to more transparency and quicker digestion of information.”
Jim Brown, SVP of Network Performance, explained during our webinar, Ghost Networks: Are They Haunting You?
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