The Role of Provider Data Management in Online Provider Directories

Over 70% of last year’s credentialing survey respondents indicated their credentialing solution is the single source of truth within their organization. One of the downstream recipients of the data (via either export, API or a portal) is the online provider directory.

Knowing information from your solution will be available to the world brings to light some key considerations.

Data Standards

Best business practice includes having documented rules about the format and use of data elements in your credentialing solution. This need becomes apparent when looking at provider information online.

Data entry standards should include standardization guidance on:

• Abbreviations (e.g., Suite should be entered as Ste.)
• Required fields
• Approved information source (e.g., enter last name from state license)
• “Do not use” fields

Data and Image Quality

Another consideration is the quality of the data and the provider images. Using business rules for data entry does not automatically result in high data quality. This requires data stewardship, training and ongoing quality review.

A typo entering a provider’s address could not just result in misguided mail. With an online directory, it could mean a new patient never finds the provider’s office.

I have visited online provider directories where no image would have been better than what was used. Photo quality issues include:

• Out of focus
• Too light or too dark
• Setting
• Very old images

You don’t want potential patients scrolling past the provider just because the photo isn’t high quality or up to date. So instead of using that security badge photo, require a professional image of every provider to be used in the online directory as well as other business uses.

CMS and State Directory Requirements

If your single source of truth downstream feeds includes a Medical Advantage organization then online provider directory guidance issued by the Centers for Medicare and Medicaid Services (CMS) is another consideration. Keep in mind your state may also have managed care provider directory standards. For example, the California Department of Managed Care issues minimum provider directory requirements in late 2016 with compliance date of January 1, 2018.

The CMS requirements includes auditing for compliance with potential penalties. In their second online provider directory review report it was disclosed that 52% of the reviewed directories had at least one inaccuracy. That was an increase from 45% the previous year.

The organizations with errors to date have received notices of non-compliance and/or warning letters. However, CMS has stated that there is the potential for monetary penalties and/or enrollment sanctions.

Best Practices for Data Quality

As the owner of your organization’s single source of truth for provider data, there are practices you can put in place to improve the quality of provider information. A few ideas are listed below:

• Internal Audit: Implement a data audit program to review the quality and accuracy of provider data entered in your credentialing solution.
• Image Standards: Require current professional quality photos from providers.
• Business Rules Document: Develop a business rules document including what data elements are required for every provider and standards of each field. Review and update as needed on a regular basis.
• Proactive Outreach: Medicare Advantage Organizations are required to have at least quarterly communication or contact with providers to not only review availability but also for any changes that impact directories such as location, phone, and office hours. If you don’t have an MAO, this may not be required but regular communications to confirm or update pertinent information is recommended.

The result of these practices is quality data for all downstream feeds and enabling the online provider directories to do its job of bringing new patients to the organization’s providers and services.