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Updating Provider Data

Insurance companies are not keeping provider data updated in their directories. Patients use the directories to make sure a provider is on their specific plan and what their demographics are. Directories are supposed to help the consumer gather all of the important information before calling a physician’s office and making an appointment. What we are finding is that provider directories are not always up to date and this requires the patient to find another provider. Beginning in January 2016, the Centers for Medicare and Medicaid Services (CMS) put new regulations into place that will now fine insurance carriers for having errors in the Medicare Advantage Plan directories. The fines are specific to policies sold through the health care exchange, however, CMS is highlighting an issue that is broad and not exclusive to one plan or carrier. There are many moving parts that need to take responsibility for updating the data. First, if there is a change to a providers demographics or a policy change, they need to let every insurance carrier know about those changes. Secondly, the insurance company needs to update that change in a timely manner to the providers profile and upload it to the directory. Patients rely on this information to be correct so they are sure they can ensure their claims will be paid by the carrier. Providers rely on the carriers to promote the locations, phone numbers and participating providers in their office correctly so patients can find them. Are you updating all of your information with your carriers? 

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