Addressing the increasing expectation on health plans to present patients with accurate directories of available health care professionals, the American Medical Association and LexisNexis Risk Solutions are collaborating to offer a solution intended to maintain high-quality data for use in network directories.
The partnership is part of a plan to streamline both operational and regulatory compliance aspects of provider directory management, expected to grow in importance as accountable care organizations take hold and create new alliances and relationships between providers.
The collaboration combines the data resources of the AMA, its wholly owned subsidiary AMA Business Solutions, and LexisNexis Health Care, which offers database and analytic technology. The joint effort will result in LexisNexis VerifyHCP, a service that will pre-fill, collect, monitor, cleanse and update clinician data in real time.
The solution, to be available by the end of the year, will create efficiencies for health insurers and clinicians that streamline the process of maintaining an accurate and up-to-date network directory.
Health plans are increasingly mandated to keep their provider directories accurate; providers have to address repetitious data verification requests from payers; and consumers want to be sure providers’ information about network affiliation is accurate. The AMA and LexisNexis say their approach will be able to provide accurate lists of healthcare professionals for payers; for providers, it will offer a simplified alternative to updating practice information with multiple payers; and it will assist patients by being a source of accurate network directories.
Changes to clinician data naturally occur and erode the accuracy of network directories. Accurate directories are necessary for consumers to make informed decisions and enrollees to find suitable medical care. As federal and state agencies tighten regulations for providing patients with up-to-date and accurate lists of health care professionals, health plans face an evolving mix of rules and mandates. As a result, physician offices are burdened with an increase in repetitious data verification requests from health plans that are required to constantly ensure the quality of network directories.
“It has never been more important for both operational and compliance purposes to identify, validate and update clinician data in real-time,” said Josh Schoeller, vice president of client engagement at LexisNexis Health Care.
“LexisNexis Health Care provides unique analytic technology and proven capabilities that complement the AMA’s extensive data resources and supports the important goal of providing patients with accurate network directories,” said Laurie McGraw, AMA senior vice president of health solutions. “Working together to solve a significant industry challenge will provide physicians a simplified alternative to updating practice information with multiple payers that reduces administrative burdens and workflow disruptions.”
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