##### 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! ##### LEARN MORE **QUESTANALYTICS.COM**