ACA COMPLIANCE (PROVIDER DIRECTORY)

Industry: PROVIDER DIRECTORY

Background: Health Plan’s inaccuracies in provider directories hinder consumers’ ability to identify network provider. Inaccuracies also make it hard for finding the right plan and manage healthcare cost. ACA required all QHPs make in and out of network provider’s information transparent

Problem: The information displayed on the Provider directory is constantly updating. The provider’s location, contact information, specialty, medical group, institutional affiliations are constantly being updated. This process is high maintenance as insurers are required to update the directory once a month.

Solution: A Real-Time Provider Directory update is the immediate solution. When using the credentialing system, this information is automatically integrated, to update online provider directory and backend claims system.

Background: Health Plan’s inaccuracies in provider directories hinder consumers’ ability to identify network provider. Inaccuracies also make it hard for finding the right plan and manage healthcare cost. ACA required all QHPs make in and out of network provider’s information transparent.

Result: Time management, as we can upload delegated credentialing, saving time and avoiding costly errors. Accuracy of referrals and authorizations, as providers can be accurately verified as an in-network provider prior to submission.