Findings Based on a Sample of Over 500,000 Verifications Conducted in 2022, 2023; Federal Law Now Requires Quarterly Updating
June 7, 2023; East Brunswick, NJ: Consumers today increasingly rely on web-based insurance company directories to find the best health providers for their needs – doctors and others who offer the locations, specialties, languages spoken, and other qualifications that they need.
But recent research by Atlas Systems shows that nearly 40% of health plan directory listings have outdated information, creating potential confusion and added expense for patients – as well as liability for the insurance plans themselves.
As part of its ongoing PRIME® service – the gold-standard method for verifying health directory listings – Atlas checked thousands of provider listings in 2022 and 2023, contacting doctors and their practices directly to make sure their information is current. The research showed that 37% of listings have at least one error among key points commonly displayed in online directories.
The most common change, found in 18% of listings validated, is “Not at Location” – when a particular doctor or other provider can no longer be found at a certain office.
Atlas also found thousands of changes or mistakes in such key areas as:
- Specialty
- Telephone Number
- Hospital Affiliation
- Office Wheelchair Accessibility
As part of the 2022 No Surprises Act (NSA), insurance providers are now required to update their directories on a quarterly basis.
“A health plan’s network is its greatest asset – and the accuracy of the information there plays an important role in the member experience and brand identity,” said John Lamb, Vice President of Provider Operations at Atlas Systems. “Despite increasing regulation – from the NSA and state laws – we found that directory accuracy has improved little since the Center for Medicare and Medicaid Services (CMS) studied this issue five years ago. Clearly, keeping provider listings current is anything but a slam dunk – and is now more urgent than many providers might have suspected.”
A service of Atlas Systems, PRIME® offers a rigorous, proven approach to provider data validation – helping insurance plans deliver great member experiences and stay in compliance with the No Surprises Act. We achieve best-in-class provider data accuracy with 95% client-audited quality assurance and up to 90% validation success. While other services rely on data aggregation – using sources of unknown reliability – PRIME delivers data validation from the source, reaching out directly via convenient channels to contracted health systems, provider groups, and individual practitioners
About Atlas Systems
With offices in the US and India, Atlas Systems is a trusted partner helping companies on their digital transformation journeys – expanding their capabilities and delivering added value. Leveraging innovative technologies, such as AI and Cloud, Atlas works closely with clients to provide technology solutions that seamlessly enhance in-house teams and systems.
