Future-Proof Your Provider Directory Management: 5 Reasons to Embrace Automation

Provider directories not only help members find health care, they are pivotal in achieving operational efficiency and meeting regulatory standards. Maintaining provider data management and up-to-date provider directories is essential for the success of health plans. Provider directory automation is an investment in the future of your health plan and your members. Here are five compelling reasons to transition from outdated, legacy processes to a streamlined, automated system:

1. Enhanced Payment Integrity

Outdated or incorrect provider information often results in low rates of first-pass claims payments. Automating your provider data ensures accuracy, aligning submitted claims with current data, thus facilitating the claims process. This accuracy also mitigates issues in complaints and grievances processes, driving efficiency in these critical areas.

2. Compliance with Regulatory Standards

With the healthcare industry under scrutiny for wasteful spending, federal laws like the No Surprises Act are putting pressure on health plans to maintain current provider directories. Plans face new risks for the consequences of unexpected out-of-network charges, and the trajectory of this regulatory activity is clear: plans will be held accountable for failing to clean up provider networks.

3. Improved Access to Health Care

The US is experiencing a mental health crisis inaccurate listings of health care providers who are not actually available for appointments (e.g.: not accepting new patients, retired, moved away, or no longer accepting the particular type of insurance)., often referred to as “ghost networks,” negatively impact member satisfaction. Ensuring accurate and accessible provider information is crucial, not just for member satisfaction but also for addressing broader public health challenges due to inadequate access to care.

4. Simplified provider onboarding

Automating provider data operations streamlines the onboarding process. Plans that can incorporate reference data at scale and leverage modern technology no longer struggle manually with delegated rosters, sanctions checks and expirables. Whether credentialing in-house or leveraging a CVO, all plans have opportunities to make onboarding more seamless.

5. Operational Efficiency and Cost Savings

To build a business case for investing in provider data automation, look at your people. Automation can free up your team from the time-consuming task of manually reviewing, managing and manipulating provider records, allowing them to focus on more strategic initiatives. This shift not only saves time but also translates into significant cost savings for your organization. Your team will thank you for the shift away from spreadsheets, flat files, and Access databases.

See how VillageCare used Convergent to Automate Their PNDS Reporting Error.