In the News

Why Can CA Regulations Fix Medical Provider Directory Accuracy?

California is attempting to attack the problem by pairing the Golden State’s most dependable weapon—regulatory muscle—with clever technology - Gaine Technology.

Why Resolving Patient ID Issues is a Top Priority

Accurate patient identification is a fundamental prerequisite for quality care, which is why resolving the long-standing patient matching challenge has moved front and center as a top priority.

IHA Selects Gaine Healthcare for California PDU

The Integrated Healthcare Association (IHA) announced their selection of Gaine Healthcare and Availity as the technology vendors for the launch of the statewide Provider Directory Utility (PDU).

CMS Wants Docs to Spend More Time on Patients, Less on Paperwork

The CMS has launched an initiative that it hopes will lead to less provider regulation, allowing doctors to spend more time with patients.

A Provider-side Approach to Provider Directories plus SB137

Part of an ongoing Provider Directory series that aims to dissect the issue from all perspectives, including provider, payer, patient, and regulator. The goal is to help facilitate an expanded national conversation that drives us towards an open, collaborative industry solution.

DMHC Uniform Provider Directory Standards

In this document, the California Department of Managed Health Care defines provider directory standards with a compliance date deadline of January 1, 2018.

California's Coverage Expansion: Fiscal and Political Risks

On May 4, 2017, with the passage of the Republicans’ American Health Care Act (AHCA) in the US House of Representatives, a sharp tremor was felt by California’s vast health system.

Inaccurate Provider Directories Create Barriers to Care

The Centers for Medicare & Medicaid Services (CMS) released a report in January on the accuracy of provider directories, the online lists provided by insurers and used by health plan enrollees to find in-network doctors or select a plan in which their preferred caregiver participates.

ACP Aims to Reduce Administrative Burden on Docs

An avalanche of paperwork may be destroying the physician-patient relationship and driving some doctors out of practice, and the American College of Physicians is again demanding an end to it.

Insurers' Flawed Directories Leave Patients Scrambling for In-Network Doctors

As consumers review their coverage and shop for 2017 insurance through the federal health law’s online marketplaces during the annual open enrollment period, many of the directories they are using are outdated and inaccurate.

21 Medicare Health Plans Warned to Fix Provider Directory Errors

Federal officials this month warned 21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrolling people if the problems are not fixed

Rural Docs Move Into Value-based Payment

Five steps for hospitals to prepare for MACRA's Quality Payment Program.

Sanator Symphony Provider Directory Launches

Symphony has been designed to meet the regulatory and business reporting requirements of SB 137

California Regulator Slams Health Insurers Over Faulty Doctor Lists

California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report.

Nearly half of MA Provider Directories Reviewed by CMS are Wrong

A report released by the CMS revealed 45.1% of provider directories of Medicare Advantage plans reviewed were not accurate. The agency examined the online provider directories of 54 Medicare Advantage plans, which represents approximately one-third of all MA plans, between February and August of 2016.

Insurers' Flawed Directories Leave Patients Scrambling for In-Network Doctors

As consumers review their coverage and shop for 2017 insurance through the federal health law’s online marketplaces during the annual open enrollment period, many of the directories they are using are outdated and inaccurate.

Provider Directories - Driving Accurate Lists for Consumers

A directory should be a living document that changes daily to reflect the evolution of a health plan's provider network.

Kicking off HIMSS16, John Halamka Delivers His Call to Action for Health IT Industry

In his opening keynote for the Physicians' IT Symposium at the HIMSS16 conference in Las Vegas, John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston, reflected on how health IT has progressed in the last decade, and what the industry can do better moving forward.

CMA Publishes Guide on New Provider Directory Accuracy Law

The CMA has published a new guide to help physcians understand the new law and what they need to do to avoid penalties.

Biggest Obstacles to Patient Centered Care? Coordination and Quality Measurement

It starts with an active, dynamic health directory, Pletcher said, because it captures which provider is part of a given practice unit, and in turn how that practice unit connects to any associated contracting entities such as physician organizations, accountable care organizations and patient-centered medical homes.

How the Cures Law will Force Interoperability to Move Forward *

The new 21st Century Cures Act is about to change healthcare IT, and most of the industry never saw it coming.

Sanator Provider Registry Brief

This paper offers insightful statistics gathered since the launch of Sanator in July 2016. Learn how health plans can interface with the Sanator Registry and how this impacts their relationship with individual physicians and provider organizations.

Medi-Cal Enrolees in Santa Clara Family Health Plan Have Trouble Finding Doctors

Medi-Cal enrollees in the Santa Clara Family Health Plan may have trouble finding a primary care doctor willing to treat them, leading many to use high-cost hospital emergency rooms and government-funded free clinics — or defer care altogether, a new report from the county’s civil grand jury says.

CMS Begins the New Year by Instituting Fines for Error-Filled Provider Directories

Health insurers now will face fines as high as $25,000 per beneficiary as a sanction from regulators in many states for errors in provider directories that can result in patients receiving surprise out-of-network bills.

How States are Improving Consumer's Access to In-Network Health Care Providers

This blog discusses how Georgia, Maryland, and Colorado are making progress on implementing standards for network adequacy and provider directories to improve consumers’ access to providers in the private insurance market.

DMHC Fines Blue Shield and Anthem for Inaccurate Provider Directories

The California Department of Managed Health Care (DMHC) announced today that it issued a $350,000 fine against Blue Shield of California (Blue Shield) and a $250,000 fine against Anthem Blue Cross (Anthem) for inaccurate provider directories.

NAIC Network Adequacy

Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract.

EHRs Eat Up Docs' Time

According to a study in the Annals of Internal Medicine, physicians spend nearly two hours a day on EHR and desk work during office hours.

Many Errors in Online Doc Directories, CMS Finds

Learn what the CMS has learned during its ongoing review of online provider directories. Nearly half of Medicare Advantage provider listings have errors.

Health Insurers to Face Fines for Not Correcting Doctor Directories *

In an attempt to remedy mistakes in doctor directories that have become an inconvenience for patients, new federal regulations will make such errors costly for insurers by  allowing the Centers for Medicare and Medicaid Services to fine insurers up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run insurance exchanges in 37 states. Furthermore, some States are starting to impose their own rules and sanctions.

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