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    Provider Directory Data Accuracy or Surgery: Which Is More Difficult?

    By Cassandra Bannos • September 12, 2018
    Provider Network Data Integrity is the Foundation of Good Referral Management

    I like to joke with my doctor friends that the most difficult part about healthcare is the data. Yes, surgery is incredibly complex but have you had to keep track of a surgeon’s demographics, insurance participation records, network status, clinical preferences, support staff roster, or scheduling templates across multiple locations and multiple location types (clinic vs. inpatient vs. billing)? What about keeping track of that for all of the doctors in a practice, a system, or a market? And what about when that information can change daily?

    It’s no secret to anyone who works in or is familiar with the healthcare system that there is a unique set of challenges to managing and keeping administrative information, such as provider directories, up-to-date. Data elements such as NPI, name, and board certifications are unique to that provider across each of their locations. Data elements such as address, tax ID, and practice name are unique to an office.

    But then there’s a set of data -- most importantly insurance acceptance -- that may vary by provider by office. For example, Dr. Vilfredo (represented by Provider 2 below) can accept Gold Insurance Plus at her Milk Street office (represented by Office 3 at Group/Practice 1), but not at her Central Street office (represented by Office 1 at Group/Practice 2).


    Even within an organization, it’s unlikely to find a single source of truth for this type of data. Insurance companies themselves have difficulty with keeping track of which providers are in their network and with maintaining the appropriate location information for those providers. The most recent analysis by CMS found that over 50 percent of locations listed across Medicare Advantage plan directories had errors.

    Health systems and healthcare delivery organizations often have multiple legacy system that hold different pieces of the puzzle. The credentialing database has some of the base information, but another system holds insurance par information and yet another has office details. There’s a complex web of maintenance and data governance attached to keeping these disparate systems in sync. 

    Yet, the foundation of a provider network - and consequently a referral management system - is its providers, and so the accuracy of its provider directory is paramount. And maintaining accuracy throughout the year is much more difficult than striving to achieve accuracy at various intervals.

    Provider Network Data Integrity is the Foundation of Good Referral Management

    At par8o, we’ve developed a philosophy and subsequently the technology to overcome many of these challenges. Instead of relying on inaccurate and multiple source systems for data maintenance, we believe in decentralized, crowd-sourced data management.

    Staff at each individual provider’s office has the most up-to-date and detailed information for that provider. Our provider directory allows specifically-designated staff to maintain data while respecting complex architecture and profile compositions. Instead of relying on surveys, phone calls, or even faxes to update information, providers and staff can do so directly in par8o and this information is both available for immediate use.

    Why does this work? As a referral management software solution, referral coordinators are uniquely motivated to make these data updates. Incorrect data causes them time delays and complaints from patients, so they personally benefit from updating incorrect misinformation. Likewise, specialist offices that are trying to increase referrals benefit from making sure data is accurate and readily available. And finally, if insurance par data becomes outdated, providers miss opportunities to capture patients or may artificially have schedules blocked. 

    Relying on a few key staff for a system-level improvement in data quality? Now that’s pareto optimality!