A large national health plan needed to improve the quality of its directory data for Medicare Advantage plans, reduce CMS audit risk and improve member satisfaction. Provider outreach efforts to improve data quality improvement were costly and were not achieving desired results. The plan partnered with CAQH to execute a pilot initiative across the state of Texas to replace outreach calls with system-generated messages - only to providers with missing our outdated records.
Although the phone calls resulted in small directory improvement, the approach was resource intensive, costly and accuracy increases were not sustainable.
CAQH sent Net Promoter Score2 surveys to providers to find out how they felt about the new directory management process.
The survey asked, “What do you value the most about the CAQH Directory Management Solution?” Providers gave high marks for usability and how easy it is to share data with multiple plans.
“Simple,” “Easy,” “All-in-one,” and “User friendly” were the top responses.
After 3 months, the plan performed an internal CMS-style audit of the provider directory records from the CAQH workflow. Nearly 40,000 providers or 76% had completed profiles and attested to their data. Another 20,000 outdated records were removed from the system. The net result for the health plan was an 84% accuracy score for its provider directory data, far exceeding the national average of 50%1 or lower.