The State of Provider Directory Accuracy

By Claire Thayer, December 13, 2016

Despite a federal mandate for all plans in the health insurance marketplace be required to have current and accurate provider directories, many health plan enrollees are finding that when it comes time to call a provider for their specialty visit or find a new primary care physician willing to take new patients, the information in the directory is often out of date or missing vital information.

We’ve posted a couple of infographics on this topic, one on the Accuracy of Health Provider Directories which outlined data points that CMS requires health plans to monitor and maintain on a monthly basis and the State of Provider Directory Accuracy Across the U.S. which outlined provider penalties that could be incurred for inaccuracies.

Last week, The New York Times published an in-depth article, Insurers’ Flawed Directories Leave Patients Scrambling for In-Network Doctors, highlighting from the consumer perspective just how frustrating the experience can be when you’re the patient shopping for health coverage and trying to find a physician willing to accept new patients.

While health plans participating in the health insurance marketplaces were to be subjected to penalties for directory inaccuracies starting in 2016, research by the New York Times found that while many directories are still incomplete, inaccurate or missing information, so far no plans have been fined or kicked off the enrollment sites for having poor doctor directories, said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which would enforce the rules. A Health and Human Services Department survey of Medicare plans for those 65 and older that was released in October found errors in nearly half of the listings in doctor directories .

Last week, the MCOL Infographoid, co-sponsored by LexisNexis Health Care, offered a deeper look at the provider directory requirements on a state by state basis in the State of Provider Directory Accuracy, 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.