NSA-BeforeAndAfter-IG-110524
NO SURPRISES ACT
PROVIDER DATA ACCURACY
EXAMINING THE EFFECTS OF
PROVIDER DATA
ROUTINE MANDATES FOR PROVIDER VERIFICATION
Under the No Surprises Act, group health plans and health insurance issuers are required to regularly verify provider directory data every 90 days. If they fail to verify the information within that time frame, they must promptly remove the provider or facility from the directory.
PROVIDER DIRECTORY VERIFICATION REQUIREMENTS
| health insurance | respond to consumer | establish a provider | update their directory |
|---|---|---|---|
| issuers must verify | provider directory | directory verification | database within two |
| and update their | telephone calls within | process and develop | a procedure for |
| provider directory | one business day of | removing providers and facilities with unverifiable information. | provider update. |
ASSESSING THE IMPACT ON PROVIDER NETWORK STRENGTH
INVESTIGATING THE IMPLICATIONS OF NON-VERIFIED PROVIDERS
What would happen to a provider network if a health plan removed providers who had not verified their information in the last year?
- One county in New York
- Primary Care Physicians who had not attested to their information in the last year were removed from the network analysis.
REVEALING THE RESULTS
3 COMPELLING ARGUMENTS FOR ACCURATE PROVIDER DATA
INCREASED TRAVEL DISTANCE
TO PRIMARY CARE PHYSICIANS
The average distance required to reach a Primary Care Physician rose significantly from 4.2 miles to 34.3 miles, leading to inconveniences for patients seeking timely medical attention.
MILES
34.3 MILES 4.2 Provider is no longer Next closest provider in the directory in the directory
Will your members drive 8x farther to see a provider who is in your network and in your directory?
8X FARTHER
DECREASED PRIMARY CARE
PHYSICIAN AVAILABILITY
With a lack of provider attestations, the availability of Primary Care Physicians witnessed a substantial decline of 90%, further exacerbating difficulties in accessing primary care services.
PRIMARY CARE
PHYSICIAN AVAILABILITY
DECREASED BY 90%
If you lose 90% of What’s the impact on the What’s the
your access points, 10% of the providers who are opportunity for what happens to in your provider directory – provider
wait times? how will they react? abrasion?
REDUCED MARKET PRIMARY CARE
PHYSICIANS REPRESENTATION
The proportion of Market Primary Care Physicians declined by a staggering 91%, limiting choices and impacting your market strength.
Share of market
Primary Care Physicians
91% in-network went from
12.6% TO 1.1% — A 91% DECREASE
How will this affect your market standing?
PROVEN METHODOLOGY
CLOSED-LOOP, ATTESTER-DRIVEN OUTREACH SOLUTION
To tackle the challenges posed by network adequacy and provider data accuracy requirements, health plans need a comprehensive solution and approach that can ingest data from multiple sources across various input channels and perform regular outreach to providers. Quest Analytics ® can help health plans with this challenge, providing a comprehensive solution to ensure network adequacy and data accuracy compliance.
Multi-Channel Analysis &
Network Outreach Inspection Actionable
Data Rolling Outreach Multi-Source Insights Ingestion at 90 days Verification QES ® Core
Aggregation & Provider Confidence
Consolidation Attestation Scoring
One To Many Individual & Group Machine Learning
Uniquely Quest Analytics ® Consulting
Book a free consultation today to discover how we can help you reclaim your time and achieve your
provider data accuracy goals!
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