Health plan group pilots program to improve physician directories

April 01, 2016
Area(s) of Interest: Payor Contracting Practice Management Payor Issues and Reimbursement 

America's Health Insurance Plans (AHIP) is launching a pilot program to ensure that physician directories are more accurate and up-to-date, the organization announced last week.

The pilot program involves two directory vendors, BetterDoctor and Availity, and will include providers in three states: California, Florida and Indiana. The pilot program will run from April to September, according to AHIP, and will include the following eight California plans:

  • Anthem Blue Cross
  • Blue Shield of California
  • Health Net of California
  • Humana
  • LA Care
  • Molina Healthcare of California
  • SCAN Health Plan
  • Western Health Advantage

As part of the pilot program, BetterDoctor will be reaching out to provider offices that are contracted with any of the eight plans via phone, fax and email to confirm physician and practice demographic information.

The pilot will also help to ensure health plan and provider compliance with SB 137 requirements, which take effect July 1, 2016. The new law requires plans and insurers to comply with uniform standards and provide timely updates to their provider directories. The law includes multiple components aimed at providing patients with more accurate and complete information so they can identify which providers are in their payors' networks.

It’s important that practices respond in a timely manner to the verification requests, as the new law not only requires payors to maintain accurate and current directories, but it also requires physicians to do their part in keeping the information up-to-date. Failure of practices to comply with the new requirements may result in payment delays, removal from directories and even contract termination.

The new requirements underscore the importance of ensuring that practice demographic information, including whether or not the practice is accepting new patients, is up-to-date with contracted payors and any changes to practice demographics are communicated to the plan/insurer in a timely manner.

The pilot program will also help to alleviate the administrative burden on practices by reducing the number of plans individually reaching out to providers to verify practice information. AHIP said that the six-month pilot would take cooperation from both providers and health plans to make the program work.

At the end of the pilot, AHIP will conduct an independent evaluation using feedback from providers, health plans and consumers, and will then develop best practices. AHIP is funding the project.

The California Medical Association will be hosting a webinar on the topic with AHIP and its California vendor, BetterDoctor, on Wednesday, April 27. The webinar will cover an overview of the pilot program and the requirements of SB 137, including its effect on physician practices, as well as what to expect in terms of outreach and the information requested by the vendor.


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