« Studies on Prescription Drugs and Social Media | Main | NCQA Releases 2017-2018 Health Plan Ratings »

Provider Data Accuracy – Continued Challenges for Health Plans

By Claire Thayer, September 27, 2017

Inaccurate provider directories continue to pose challenges for health plans both in terms of removing barriers to patient care as well as the monumental task of keeping track of network providers and managing all data elements associated with a single provider record.  Not only is the data constantly changing, consider this: documenting this information takes time as a detailed record can track up to 380 distinct line items, including service locations, billing locations, payment locations, specialties, certifications, affiliations, office hours, and languages spoken.  Regulations have been enacted on both the federal and state level on required data elements and timeliness of maintenance requirements, with penalties for non-compliance and regulations that vary widely from state-to-state.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, focuses on increasing challenges for health plans with data reporting and maintenance of provider directories:



MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Reader Comments

There are no comments for this journal entry. To create a new comment, use the form below.

PostPost a New Comment

Enter your information below to add a new comment.
Author Email (optional):
Author URL (optional):
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>