This law mandates that health organizations ensure provider directories are current and accurate. Health plans are required to verify provider contract status and updates every 90 days and remove any unverified providers. More frequent provider directory updates will require faster than ever – within 48 hours - provider verifications. This near-real-time directory maintenance will require ongoing updates with agile technology and auditing systems that can meet the requirements for faster turnaround times. This law aims to protect patients from unknowingly visiting an out-of-network provider. Health plans and organizations that do not comply could not only face penalties, but also risk member and provider abrasion.
Provider database management is more important than ever. Here are the top three benefits health plans and payers can reap by harnessing provider database management solutions:
Ensure Compliance with the No Surprises Act
To comply with the No Surprises Act legislation, health plans must ensure their databases are updated within 48 hours of receiving demographic changes from providers. The most effective and straightforward way to update databases is through automation. With automation, provider information can be updated each night and automatically inform databases directly.
Beyond keeping databases updated, automation can provide dashboard visibility that can drive process refinement specifications. For example, HGS Healthcare’s Provider Forward, a workflow management tool, enables real-time tracking of inventory logs for health plans to utilize in their reporting.
Most notably, the tool optimizes leader productivity, by clearing backlogs for more productive adherence to processes. This not only helps with No Surprises Act compliance but gives health plans better ability to track their historical data, in avoidance of penalties and providing increased audit success.
Undependable directories create poor member experience by affecting access to care. A common constraint that many health plans face is members calling theirtoll-free number to ask about a provider. An influx of calls can cost health plans time, money, and lead to member dissatisfaction. Take, for example, a deceased provider who is shown active in the directory. In these cases, members often become frustrated because they get a wrong number. Another example is when a provider isn’t taking new patients despite the health plan information indicating they are and it wastes member’s time.
These experiences impact member loyalty. Health plans do make mistakes, but directory errors may also happen because providers are not informing the health plans of these updates. This new legislation will not only improve member loyalty but will also increase member trust when the information is accurate. When members are satisfied, call volumes and numbers of claims are reduced.
Lessen the Administrative Burden on our Healthcare Workers
Automation not only allows for health plans to ensure No Surprises Act compliance but can also greatly reduce the administrative burden on workers. It’s no surprise that health plans are constantly processing an abundance of provider data, and it’s an ongoing challenge for plans to assess, interpret and enter it into the system. However, recent advances in technologies now make it possible to automate the millions of human hours spent cleansing and keying in this data every year, as well as improve its accuracy.
Put more simply, a workflow tool such as Provider Forward, whichleverages automation and bot deployment, can apply multiple validation rules to ensure clean entry into the master provider database.
This solution helps identify and translate unstructured data into structured data. The intelligent bots pick up the cleaned data and update the system. The automation includes scrubbing of rosters supported by bots that capture key data for insights. Data collection and verification are performed outside of the core system. The tool can provide cleaned output files in most industry-standard formats.
These new technologies will help ensure compliance while enabling the plan’s employees to focus on member satisfaction and keeping them healthy.
While the new legislation is highly focused on health plans, providers have a key role to play as well. Providers need to be held accountable - and hold themselves responsible - to inform health plans of updates. It’s critical for providers to reach out every three months to provide updates. As the industry will change due to this new mandate, we will only be able to succeed when everyone plays their part and works in tandem.
Health plans need to invest in technology and automation now, so they can reap the benefits.Harnessing provider database management solutions will ensure compliance, enhance member loyalty and reduce administrative burden on workers ahead of the No Surprises Act deadline. Our healthcare workers won’t be able to do it alone—turn to the experts for the required people, process and technology.
