DataSpring, powered by CAQH, assembled a collective of insurers, along with the American Medical Association, to launch a new standard to measure provider directory data quality for individual clinicians on Oct. 13.
DataSpring, owned by major health insurers, bridges payer and provider data. Along with DataSpring and the AMA, the Provider Data Collective includes Aetna, Centene, Cigna, Elevance Health, Horizon Healthcare Services, Humana, the National Committee for Quality Assurance and UnitedHealth Group.
In an Oct. 13 news release, Tim Kaja, executive vice president of UnitedHealth Group Enterprise Services and board chair of DataSpring, said inaccurate provider data can contribute to barriers in healthcare.
“Patients struggle to confirm whether a clinician is in-network, providers face delays joining networks and seeing patients, and care teams often lack the reliable information needed to coordinate care,” Mr. Kaja said. “While CMS established a method to measure provider data accuracy, inconsistent application made it difficult to establish a common baseline for improvement of provider data quality across the industry.”
The news release said healthcare organizations and government programs have had their own methodologies to evaluate provider data quality, resulting in inconsistent measurements. In three months, participants in the collective formed a framework rooted in the CMS quality foundation for provider directories.
The collective said one of its next priorities will be assessing how accepting-new-patients status is determined and reflected in directories.
Directory accuracy has been particularly pressing for insurers. State and federal legislation has pushed for more accuracy with these directories, as well as checks for “ghost providers,” listed providers who are out of network, unavailable or inaccessible. Amid these efforts, UnitedHealthcare recently sent letters incorrectly informing members that eight clinicians had died before correcting the mistake.
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