CAQH expert on provider directory problems: Go for accuracy, hope for a common platform

by: Roy Edroso Dec 9, 2019

(In the current issue of Part B News we talk about a new report from CAQH that calculates the average cost per month for directory maintenance at close to $1,000, and how practices can reduce that. Ron Urwongse, a senior product manager with CAQH, talked to us about the interoperability issues that have helped make things so difficult, and how the problem might be resolved in the future.)

Your survey report suggests that a technical single-platform solution on the provider end would help ease provider directories maintenance. What would you say to providers who think that this is a waste of money, especially since most of the current enforcement burden is on the payers, not the providers?

We’ve estimated that providers are incurring $2.65B to maintain directory records across all of their contracts. A single platform would reduce the redundant data entry, the phone calls, and would standardize and simplify the process for all providers. AMA and MGMA have both conducted surveys demonstrating that providers prefer a single channel across all plans. The regulatory environment is also evolving such that more providers will be held liable for directory submissions -- e.g., California, and there is draft legislation at federal level around surprise bills that has mentioned this…

It would take a journey of uncertain duration for the entire industry to embrace a common platform for provider directory maintenance. We’ve heard from many in the provider community that they prefer CAQH to other commercial systems. It’s less about commercial vs. not-for-profit and it’s more that a majority of health plans are already using CAQH ProView. But there are other solution trying to reach critical mass and aspiring to play a role in the provider data ecosystem. If there were one “breakaway” platform the industry might flow naturally to that.

Having a single point person per practice seems like an obvious administrative efficiency that would reduce directory maintenance churn. Can you think of any others?

A single point person would be helpful. Automating the process of data collection and submission within the practice is also helpful. One of the most important things a provider practice can do is to understand what the health plans and CMS are expecting from directory data, and to submit their data appropriately. If the payers and regulators know that there’s a shared understanding of the definition of data quality, and provider practices can prove their data is consistently accurate to payers, then there’s an opportunity to reduce the administrative burden. Establishing an explicit industry standard around directory data quality would be helpful.

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