Free Quest Analytics Infographic

How Provider Data Accuracy Impacts Health Plan Adequacy

The Secret Key to Your Success

Fifty-seven percent of National Provider Identifiers (NPIs) have not been updated in over five years, leaving inaccurate data in a health plan’s network analysis and provider directory. Furthermore, many of the changes that happen as a result of providers updating their information are not accounted for in the health plan network analysis or made to the health plan’s provider directory. Consequently, consumers find themselves facing more barriers, more often, when needing to schedule health care appointments.

Correcting inaccurate provider data is key to the success and quality of your health plan’s network and member experience. We created this infographic to illustrate:

  • Why your network might not be as adequate as you think
  • The dangers of inflated networks
  • How to connect the links of provider data accuracy and network adequacy
  • The five barriers to access care
  • The cost of non-compliance to a plan
  • How to shift from an adequate network to an excellent one

 

1– NPI Aging analysis completed by Animas Data Solutions, LLC (Oct 2020).

Download the infographic!

Adequacy and Accuracy

How can health plans move their network from adequate to excellent?

Cari Lee, Vice President of Government Affairs, explains what health plans can do to improve their member experience, deliver better access to care and impress regulators.

CMS Results

We visually break down the results of audits conducted by CMS in 2016, 2017, and 2018. There is a good chance that the results may surprise you.

Directory errors

Barriers to Care

According to CMS, 41.7% of directories have errors. These barriers to care negatively impact your members’ experience.

Accuracy and Adequacy

From Adequate to Excellent

Plans that don’t consider both the accuracy and adequacy of their networks may create negative experiences for their members and risk non-compliance.

CMS Network Adequacy Reviews

Looking for surefire tactics to help you prepare for the Centers for Medicare & Medicaid Services (CMS) Network Adequacy Review? We’ve got you covered. Here are the best practices we’ve found to be essential for both maintaining network adequacy…and staying compliant year-round.

Provider Directory Verification Resources

Explore our No Surprises Act Resource Center to stay up-to-date on the provider directory verification requirements, find preparation guides and videos to help you develop a strategic plan to meet deadlines, and learn about the solutions that can get you there quickly.

Deliver on tomorrow’s goals by planning today

We are committed to assisting our customers in their quest for accurate provider directories and adequate health networks that maintain appropriate access to care for your members.

Schedule a consultative session with one of our network management experts to discuss and determine your strategy.

Book a Strategy Session