## Negative Quality

## Termination of
## Medicare Advantage

## THE SIGNIFICANCE OF ACCURATE PROVIDER DATA

# UNCOVERING THE HIDDEN HAZARDS OF THE PROVIDER NETWORK

## Acquire patient member member new

## ACHIEVE OPTIMAL MEMBER

Your provider network is adequate, but is it accurate? Health plans often use outdated and inaccurate provider data to assess their networks. This means you might not be providing the coverage and services you think you are. To avoid the negative consequences of an overstated network, you want to focus on improving provider data accuracy.

## INACCURATE PROVIDER DIRECTORIES

In 2015, the Centers for Medicare & Medicaid Services (CMS) received an alarming number of complaints from consumers about the accuracy of provider directories. In response, CMS conducted a review to examine the issue in more detail. What they found was shocking—a staggering number of disparities between what was listed and what was accurate.

## INACTIVE PROVIDERS

Providers are deceased, retired, or on the Office of Inspector General Exclusion List.

## Data Fuels BUILD AND ADEQUACY REPUTATION STANDARDS

### EXCESSIVE LOCATIONS
Providers are listed at more than 5 locations.

### UNLIKELY SPECIALTY COMBINATIONS
Providers are listed with multiple inaccurate specialties.

### INCORRECT PHONE NUMBER 
Providers are listed with the wrong phone number.

## DRIVE GROWTH AND

## Enhance current

### NOT ACCEPTING NEW PATIENTS
Providers are not accepting **new** patients when the directory indicates they are.

## CMS ONLINE PROVIDER DIRECTORY REVIEW Results from investigating the accuracy of providers and their listed locations

### 39.61%  
Provider should not be listed in the directory at this location.

### 26.43%  
Provider should not be listed at any of the directory-indicated locations.

## Inaccuracies included:

## STAY COMPLIANT  
## WITH QUEST ANALYTICS ™

### The provider was not at the location listed  
The phone number was incorrect

### 13.09%  
Address (suite number) needs to be updated

[https://questanalytics.com/how-we-help/qes/accuracy/#AccuracySession](/content/how-we-help/qes/accuracy/#AccuracySession/index.html)  
Contact us today to see how we can help improve your

### Phone number needs to be updated

### Address needs to be updated

### 6.91%  
The provider was not accepting new patients when the directory indicated they were.

### 4.53%  
48.74% of the provider directory locations listed had at least one inaccuracy.

A challenging issue, which is why we provide proven solutions and comprehensive services to handle the heavy lifting for you. With capabilities and continuous compliance monitoring, we’ve got you covered. With our actionable analytics, automated network modeling, and unbeatable expertise,

## THE INFLATED PROVIDER NETWORK

## HOW INACCURATE DATA IMPACTS PROVIDER NETWORKS

Health plans may believe their networks are accurate and adequate, but their data can be misleading.