5 BEST PRACTICES

IMPROVING PROVIDER DATA ACCURACY, PROVIDER OUTREACH AND OUTCOMES

Everyone’s buzzing about improving provider data accuracy and transparency these days—and for good reason. Just
like an athlete training to reach peak performance, healthcare professionals like yourself need the right strategy
and tools to succeed. In this article, we’ll dive into five best practices for improving provider data accuracy and
outreach to achieve better outcomes.

BEST PRACTICE 1: BE INTENTIONAL WITH YOUR OUTREACH

When it comes to provider outreach, not all methods are
equally effective. Incorporate these three strategies to
improve the success rates of your outreach efforts.

PROVIDER AT LOCATION

One of the most prevalent errors in provider directories
is listing providers at the wrong location. To avoid this
problem, perform what’s called location-centric outreach.
Rather than reaching out to individual providers and
asking them to confirm their various practice locations, the
location-centric approach is focused on confirming the
status of all providers at a specific location. It’s like targeted
outreach but for provider locations.

MULTIPLE COMMUNICATION CHANNELS

As you enhance your outreach methods, don’t just stick to
one communication channel. There are plenty of options
available, and we recommend using them all. Reach out to
providers through various channels like email, fax, direct
mail, and phone. The more avenues you explore, the
greater your chances of getting the necessary updates.

TAILOR TO SMALL AND LARGE GROUPS

Provider outreach is not a one-size-fits-all endeavor. Large
groups and health systems typically have more providers to
confirm compared to individual and small group practices.
You’ll want to customize your approach and adjust your call
to action accordingly to maximize response rates and make
everyone’s lives easier.

BEST PRACTICE 2: PRIORITIZE YOUR PROVIDER DATA UPDATES

Establish priorities and processes to identify and correct
the most urgent, sensitive, and high-risk areas that could
potentially cause member dissatisfaction or compromise
the integrity of your network. Consider these factors when
determining your priorities and processes.

HIGH-RISK DATA ELEMENTS

• Provider at Location Status
• Provider Status
• Provider Office Location Status

HIGH DEMAND SPECIALTY

• Primary Care
• Psychiatry
• Obstetrics and Gynecology

HEALTH EQUITY ELEMENTS

• Provider Linguistic Capability
• Cultural Competency Training
• Patient Populations Served

BEST PRACTICE 3: AUTOMATE YOUR DATA INTEGRATION

Manual sorting of massive amounts of data can cause
delays and lead to outdated information. Automation tools
such as an application programming interface (API) allow
you to quickly integrate the information you receive from
providers into your system.

API INTEGRATION: STREAMLINING PROVIDER UPDATES

APIs open doors to seamless updates and enhancements,
making life easier for your I.T. team. While ensuring that
you won’t be locked out of new data and giving you the
ability to effortlessly find and analyze the specific data you
need, exactly when you need it.

BUILD UPON YOUR EXISTING INVESTMENTS

API integration builds upon your existing investments,
so you don’t have to throw away all that hard work
you’ve already done. Smart investments are the key to
moving forward.

BEST PRACTICE 4: BE TRANSPARENT

ABOUT OUTREACH EFFORTS AND METRICS

Transparency is paramount in any provider data verification
strategy. It benefits executives and internal stakeholders
while keeping you compliant with regulations like the No
Surprises Act. Demonstrate your efforts to both parties by
incorporating these two types of analytics.

SUMMARY METRICS

Get an overview of your network, highlighting unresponsive
providers and essential information at the provider, service
location, and provider at service location levels.

DETAILED METRICS

Information about specific providers and facilities,
such as the last time they received an outreach, the
communication channel used, and whether the provider or
facility responded.

BEST PRACTICE 5: USE A ONE-TO-MANY APPROACH TO REDUCE PROVIDER ABRASION

Providers and administrative staff are constantly fielding
calls and emails regarding provider verification. As Steve
Slaton highlighted in the Quest Analytics® webinar,
“Facing the Realities of Provider Data Challenges to
Improve Outcomes,” this constant outreach for updating
information creates a tremendous burden on the health
plan and provider community and can lead to provider
abrasion. Here’s what you can do to minimize frustration
and streamline the process.

ONE-TO-MANY OUTREACH

Let providers update their information once and have
that update disseminated to numerous organizations.
Streamline the process, minimize frustration, and save
time for everyone involved. It’s a win-win!

INCENTIVIZE QUICK RESPONSES

Show providers how efficient and hassle-free the process
is. When they see the benefits, they’ll be motivated to
respond promptly, keeping your data accurate and up to
date. One and done.

There you have it, the inside scoop on five best practices
to improve your provider data accuracy. By implementing
these strategies, you’ll build trust with your health plan
members, stay on top of regulatory requirements, and save
yourself time and effort.

DRIVE EFFICIENCY, DRIVE RESULTS

Looking to simplify your provider data outreach
and accuracy efforts? Let Quest Analytics® take the
reins. Our solutions and dedicated team specialize
in provider data accuracy and network adequacy,
no matter the line of business. Schedule a strategy
session today to discover how we can help you
every step of the way.