Author: Kay Lynn Akers
Over 70% of last year’s credentialing survey respondents indicated their credentialing solution is the single source of truth within their organization. One of the downstream recipients of the data (via either export, API or a portal) is the online provider directory.
Knowing information from your solution will be available to the world brings to light some key considerations.
Best business practice includes having documented rules about the format and use of data elements in your credentialing solution. This need becomes apparent when looking at provider information online.
Data entry standards should include standardization guidance on:
Another consideration is the quality of the data and the provider images. Using business rules for data entry does not automatically result in high data quality. This requires data stewardship, training and ongoing quality review.
A typo entering a provider’s address could not just result in misguided mail. With an online directory, it could mean a new patient never finds the provider’s office.
I have visited online provider directories where no image would have been better than what was used. Photo quality issues include:
You don’t want potential patients scrolling past the provider just because the photo isn’t high quality or up to date. So instead of using that security badge photo, require a professional image of every provider to be used in the online directory as well as other business uses.
If your single source of truth downstream feeds includes a Medical Advantage organization then online provider directory guidance issued by the Centers for Medicare and Medicaid Services (CMS) is another consideration. Keep in mind your state may also have managed care provider directory standards. For example, the California Department of Managed Care issues minimum provider directory requirements in late 2016 with compliance date of January 1, 2018.
The CMS requirements includes auditing for compliance with potential penalties. In their second online provider directory review report it was disclosed that 52% of the reviewed directories had at least one inaccuracy. That was an increase from 45% the previous year.
The organizations with errors to date have received notices of non-compliance and/or warning letters. However, CMS has stated that there is the potential for monetary penalties and/or enrollment sanctions.
As the owner of your organization’s single source of truth for provider data, there are practices you can put in place to improve the quality of provider information. A few ideas are listed below:
The result of these practices is quality data for all downstream feeds and enabling the online provider directories to do its job of bringing new patients to the organization’s providers and services