Delivering Provider Data Validation From the Source

Assuring No Surprises Act Compliance and Delivering Better Member Experiences

At a time when consumers increasingly turn to online directories to find doctors and other health professionals, the timeliness and reliability of directory data has become crucial. Unreliable provider information can lead members to waste valuable time and even rack up unexpected medical bills – all driving low member satisfaction scores.

Accurate provider data is also a federal compliance issue, thanks to the 2022 No Surprises Act, which mandates that health plans:

  • refresh provider data within directories at least every 90 days
  • make provider-submitted changes in downstream systems within 2 days
  • remove all listings for unverified providers

The result, for insurance plans, is an urgent need that they often do not have the resources or expertise to meet. Doctors cannot be relied on to alert insurance providers when they make important moves – such as changes in location or even retirement – and overtaxed practice admins may dismiss insurance plan requests as junk mail.

PRIME — a service of Atlas Systems — solves the provider data accuracy dilemma with a rigorous, proven approach to provider data validation. 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.

Our capabilities also extend beyond provider data validation to include:

  • identifying duplicate service locations and normalizing them to USPS standards
  • validating NPIs using an industry-standard algorithm and the NPPES registry
  • meeting ADA, federal, and state regulations for print-ready PDF provider directories

Serving the needs of health plans, health systems, provider groups, and individual practitioners, PRIME from Atlas Systems eliminates compliance worries and maximizes the patient engagement experience – creating a win-win for all stakeholders.

Read our latest whitepaper on navigating the provider directory minefield here!

Want to learn more about PRIME and how you can solve provider directory issues? Contact Animesh Mozumdar at [email protected]