When selecting a healthcare provider, it's essential to have accurate and up-to-date information about who is in your network. Healthcare provider rosters play a critical role in ensuring that members have access to quality care and a positive healthcare experience. Let’s explore the impact of provider rosters on member experience, data accuracy, and compliance.
Risk for Member Experience
Accurate healthcare provider rosters are essential for ensuring members have access to quality care. Members need to know who is in their network, where they are located, and what services they offer. When provider data is accurate, members can make informed decisions about their healthcare and receive personalized care that meets their needs.
That’s why inaccurate provider rosters may result in consequences for members. Members may have difficulties finding a clinician that meets their needs, resulting in limited access to care. For example, if a member needs to see a specialist but the provider roster lists inaccurate or outdated information, this can prevent them from getting care when they need it. A 2018 CMS study found that nearly 42% of records in provider directories had errors and had a high likelihood of preventing access to care. There is a human cost to inaccurate data leading to reduced quality of care and a negative healthcare experience.
That’s why inaccurate provider rosters may result in consequences for members. Members may have difficulties finding a clinician that meets their needs, resulting in limited access to care. For example, if a member needs to see a specialist but the provider roster lists inaccurate or outdated information, this can prevent them from getting care when they need it. A 2018 CMS study found that nearly 42% of records in provider directories had errors and had a high likelihood of preventing access to care. There is a human cost to inaccurate data leading to reduced quality of care and a negative healthcare experience.
Risk for Data Accuracy
Between 20% to 30% of provider data will be outdated within a year, making it critical to maintain the data integrity of provider rosters. Accurate provider data can improve the quality of care provided to members, reduce the risk of errors in claims processing, and make operations more efficient.
The impact of inaccurate data results in claims denials, billing errors, and even financial losses. If a provider moves or retires but their information is not updated in the roster, claims may be sent to the wrong address. This results in claims denials and a disruption of the revenue cycle. Inaccurate provider data can also result in billing errors, which can be time-consuming and costly to correct.
Risk for Compliance
Many state and federal regulatory bodies require insurance companies to maintain accurate provider rosters, and failure to do so can result in hefty fines and penalties. The Consolidated Appropriations Act (CAA) of 2021 and specifically the No Surprises Act mandate that provider data updates must be incorporated within two business days of receiving new information. Failure to process these updates in a timely manner may result in federal and state fines–so automation of this process is key. Compliance with these regulations is critical for insurance companies to maintain their license to operate and avoid legal and financial consequences.
How to Improve Provider Rosters with Orderly Health
To improve the data integrity of provider rosters, data management solutions like Orderly Health can be used to intake and improve provider data. Technology advancements, such as automated data collection and verification, offered within Roster Automation Suite, can also help ensure that provider data is up-to-date and accurate.
Accurate provider rosters play a critical role in ensuring that members have access to quality care, a positive healthcare experience, and reduce your business risks.