Challenges in Provider Directory Management
Operational Costs of Maintaining Accuracy
Industry estimates suggest that Health insurers spend over $2.1 billion annually maintaining directory data. Each health plan contacts providers 8–10 times a year to update information.
Patient Impact
One-third of patients face difficulty finding in-network providers due to directory errors, which cause 20% of surprise medical bills.
Regulatory & Financial Penalties
Medicare Advantage plans are subject to annual CMS audits for directory accuracy, inaccurate directories can cause a fine of $25,000–$100,000 per incident depending on the error’s impact. About 20% of these plans have incurred penalties for non-compliance.
Resource Strain on Providers & Health Plans
Health plans allocate 30% of administrative resources to directory accuracy, limiting focus on other services.
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Scope of Services
Provider Data Validation
We ensure that your provider directory is continuously updated and validated. Our team performs regular outreach and verification processes to confirm the accuracy of provider information, including:
Provider name, specialty, and credentials
Practice locations and office hours
Contact information (Phone, Email Addresses)
Network participation status
Accepting new patients status
Languages spoken
Regulatory Compliance
Our services help you stay compliant with regulatory requirements such as:
CMS (Centers for Medicare & Medicaid Services) accuracy guidelines
NCQA (National Committee for Quality Assurance) standards for provider directories
State and federal regulations governing provider network accuracy and access
Provider Outreach and Engagement
Our dedicated team conducts proactive outreach to providers to verify and update their information regularly. We use multiple channels for communication, including email, phone calls, and online portals, ensuring that we reach providers in the most efficient way possible.
Benefits of Our Provider Directory Management Services
We offer a full suite of customer support solutions designed to meet the specific needs of insurance providers. Our highly trained agents understand the complexities of the insurance industry and are skilled at providing personalized, professional service to your customers.
Increased Accuracy and Compliance
With our thorough validation and proactive engagement, you can trust that your provider directory meets all regulatory
Improved Member Experience
Accurate provider directories allow your members to quickly and easily find in-network providers, which enhances their overall experience and satisfaction with your health plan.
Cost Savings
By minimizing claim denials and regulatory penalties due to inaccurate provider information, our services help reduce administrative costs and improve financial outcomes for your organization.
Enhanced Provider Relationships
Regular outreach and communication foster positive relationships with your provider network, making it easier to maintain accurate and updated information.
Scalability
Our solution is fully scalable, whether you manage a small regional network or a large national provider directory. We adapt to your specific needs and grow with your organization.
Our Process
Welcome to HealthyFort, a trusted partner for all healthcare organizations. Our commitment to excellence in patient care, innovative solutions, and compassion drives everything we do.
We begin with an in-depth audit of your current provider directory, identifying areas of improvement and any data gaps. Based on our findings, we develop a customized plan for managing and optimizing your directory.
We clean and standardize your existing provider data, ensuring consistency and accuracy across all entries. This involves removing duplicates, correcting inaccuracies, and filling in missing information.
Our team conducts verification processes and engages directly with providers to validate and update their information. This includes confirming contact details, practice information, and network status.
After the initial cleanup, we provide ongoing maintenance services to ensure your directory remains up to date. We perform regular verifications, manage provider changes, and offer support as needed.
We provide continuous feedback and detailed reports on the accuracy and compliance of your provider directory. Our team makes recommendations to further optimize your directory management process.
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