Improve provider directory accuracy – NE Health Plan

Improving provider directory accuracy

2 Million Member NE Health Plan Chooses PRIME for Data Remediation

A large northeast Health Plan with over 2 million Medicare, Medicaid and Commercial members, and 150K provider locations was struggling with outdated provider demographic data and a directory that was over 30% inaccurate. The Health Plan originally focused on trying to manage provider data quality in-house, but they were over-extended and data validation was not a core competency within their organization. IT resources were also constrained due to competing priorities.

PRIME was implemented to proactively validate provider data and improve data accuracy. Our solution and approach was able to quickly address regulatory concerns, with the necessary audit and recording controls. Verification was performed via various channels - including call center, email, fax and self-service - using highly trained staff.

After utilizing PRIME, the health plan achieved provider data directories with an accuracy rate above 95%.

By also including PRIME's directory publishing service, the Health Plan was able to directly integrate their provider directory production, saving time and effort on publishing costs while providing their members with the ability to download provider directories.

The health plan achieved improvements in various areas:

  • An increase in both member and provider satisfaction levels.
  • A reduction in contacts with health plan customer service representatives
  • Improved regulatory surveys and overall compliance audit results

How can PRIME work for your organization?  If you're facing a regulatory challenge, learn more about Data Quality Remediation. Looking to take a more proactive approach to data quality?  Visit our solution overview to see how you can put the benefits of PRIME to work in your organization.