Accuracy of Health Provider Directories

By Claire Thayer, December 17, 2015

Health plans participating in the federal exchange program (think Obamacare) and Medicare will be required in 2016 to monitor and maintain online directories.  CMS online directory requirements stipulate that health plans are to communicate with their contracted providers for updates on their ability to accept new patients, changes to street address or phone number, along with any of changes affecting availability to patients.

Penalties will be assessed for inaccuracies discovered in the online provider directory – and the assessment may be steep --up to $25,000 a day, per beneficiary for Medicare Advantage plans, and up to $100 per day for those covered under the federal exchange program.

A recent study into the availability of providers in the Medicaid Managed Care program found that 43% were not participating in the Medicaid managed care plan at the listed location and could not offer appointments and 35% of providers could not be found at the location listed.

These and other issues on maintaining accurate information in provider directories was the focus of a recent MCOL infographoid, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.