Tag: Provider Database Management

Solving The Challenges of Provider Database Management

By Priya Sabharwal, practice leader, network operations, HGS.

Priya Sabharwal
Priya Sabharwal

Imagine a scenario: A patient looking for a new doctor searches her insurer’s online network directory to find a provider her plan will cover. She selects what seems to be the perfect doctor based on her criteria, which could include gender, office location, languages spoken or other qualifications, in addition to being in-network with her health plan.

But there’s a plot twist: The patient eventually learns the doctor she found is not, in fact, the right option for her – but it took her scheduling and arriving at the appointment for her to realize this. It turned out the entry in her insurer’s directory was outdated, and her doctor had moved offices.

This scenario is hardly out of the ordinary. A 2019 Health and Human Services survey uncovered errors in half of the listings in Medicare plans alone. These significant inaccuracies cause issues not just for patients, but for payers and providers, too:

So what are some steps payers and health plans can take to create a solid provider data foundation? It starts with fundamentally changing the way we think about, use, enter and maintain data.

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