Tricks of the Trade to Keep Your In Tip-Top Shape

INCREASING PROVIDER DIRECTORY

ACCURACY OVERSIGHT

Provider data accuracy and transparency are common
themes in significant health policies.

If you partner with a health plan, it’s
important to know the various
regulations and put standard operating
procedures in place to be compliant.

NQTL
Comparative
Analysis
Requirement
for Mental
Health Parity.

PROVIDER DATA IMPACTS YOUR DIRECTORY

A typical Provider Network
includes anywhere from

10-30%
of providers who are
NO LONGER PRACTICING.

Inaccurate provider directories can
hinder the ability of consumers to
access healthcare services.

THE BUILDING BLOCKS FOR A TOP-NOTCH PROVIDER DIRECTORY

One way to minimize your risk and increase your member satisfaction is by maintaining
accurate provider data. We recommend you have a continuous, automatic process for
validating and auditing the information for each provider in your network.

Include Providers who
verified data as required,
and with no "red flags"
related to consumer
access.

Include but investigate
Providers who verify
data as required, but the
data inspection reveals
concerns about access.

Providers who do not
verify data in the
required timeframe
are removed from
the directory.

PROVIDER
DIRECTORY

KEY ITEMS TO LOOK FOR

Provider NPI
Are there deactivated, invalid,
missing or OIG Exclusion
listed NPIs in your data?

Suspect Specialty
Combinations
Which providers are listed
with multiple specialties?

Number of Addresses
Which providers are
listed with multiple
practicing locations?

ProTip: Fix any incorrect information and then evaluate your provider network to make sure
you still meet the network adequacy requirements.

QUESTIONS?

Let’s strategize together!