Inaccurate provider data can be very costly!

By Adrian Sanabria-Diaz | November 11, 2015


Bad Provider Data

Hospitals aren’t the only institutions struggling with inaccurate provider data. A recent Wall Street Journal article titled “Insurers,” reported that listings of insurer in-network doctors were often out-of-date. The article also cited research by JAMA that showed only 26% of providers in California were listed correctly. Inaccuracies included missing phone, fax, and address or the provider is no longer included in the insurance network.

Maintaining inaccurate provider information is not only bad business, it’s very costly. The California Department of Managed Health Care (DMHC) has fined Blue Shield of California $350,000 and Anthem Blue Cross $250,000 for maintaining “inaccurate provider directories.” The DMHC Help Center received numerous complaints from Blue Shield and Anthem individual market enrollees who could not find a primary care physician in their area or alleged they had been misled by inaccurate health plan provider network directories.

These huge fines could have been avoided if these insurers had been using Phynd Technologies Unified Provider Management (UPM) Platform that allows healthcare organizations to unify, manage and share a single, verified, custom profile on each of their providers, regardless of where that data exists in their multiple legacy systems.

The Phynd UPM helps hospitals and insurers manage and maintain accurate provider information for:

  • Billing address
  • Communication preferences
  • Licensing
  • Internal system IDs
  • Direct Addresses
  • Exclusionary lists
  • Contracting information and more.

With the Unified Provider Management (UPM) Platform healthcare organizations have the ability to manage their provider (referring and credentialed physicians, nurses, and mid-levels) profiles across all of their core financial and operational systems. 

Topics: provider, Inaccurate, provider data, Inaccurate Provider Data, Wall Street Journal, DMHC, Blue Cross, Blue Shield, JAMA

Adrian Sanabria-Diaz

Written by Adrian Sanabria-Diaz

Incorporating his degree in physics within healthcare, Adrian helps facilitate some of the backend processes of our product including data management and front end web development. He likes to keep busy by attaining his pilot license as well as dabbling into Python here and there.

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