decisionhealth Newsletters, Part B News - 2019 Issue 12 (December)
Beat the high cost of provider directory maintenance with smarter reporting
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Article Overview
This article examines why provider directory maintenance remains time-consuming and costly for medical practices and health plans. It summarizes reporting and workflow challenges, discusses payer and government pressure around directory accuracy, and outlines general practices and technology approaches that may help keep directory information current. It is relevant to practice managers, credentialing staff, reimbursement professionals, and health plan operations teams.
Why This Topic Matters
Accurate provider directory data affects patient access, payer communications, and regulatory compliance. The topic matters because poor directory maintenance can create administrative burden, network inaccuracies, and financial or contractual consequences for practices and plans.
Article Sections
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Provider directory maintenance costs and survey findings
Introduces the operational burden of directory upkeep and summarizes survey-based findings about time and cost. It also notes the role of CAQH and related credentialing workflows.
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Providers start to feel the heat
Reviews payer, federal, and state pressure related to directory accuracy and the broader regulatory environment affecting plans and providers. It also references proposed federal interoperability-related requirements and industry responses.
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Tech, or elbow grease?
Discusses the contrast between available technical tools and the need for stronger internal processes in provider organizations. It frames the issue as both a technology and workflow challenge.
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4 tips to keep clean directories
Summarizes practical workflow themes for maintaining more accurate directories, including coordination, record updates, location accuracy, and inclusion of relevant clinicians.
What You Will Learn
- Why provider directory upkeep can be costly and time-consuming
- How payer, federal, and state pressures affect directory maintenance
- What general workflow and reporting practices can improve directory accuracy
- How technology tools are being used to support directory verification
Who Should Read This
- Medical practice administrators
- Credentialing staff
- Reimbursement and revenue cycle professionals
- Health plan operations teams
- Compliance and provider relations staff
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