CAQH effort aims to clean up insurers’ provider directories

A new initiative aims to improve the quality of provider information in health plan directories, which could significantly ease administrative burdens for both providers and insurers.

CAQH is launching the initiative, building on its products already in the marketplace. More than 1.3 million providers already use the CAQH ProView credentialing database to report professional profile information to insurers, provider organizations and other entities such as regulators.

Now CAQH has launched DirectAssure, a new module in ProView enabling providers to review and update their self-reported professional information. The effort is intended to improve health insurers’ provider directories, which consumers use to find physicians who are accepting new patients; however, these directories generally are notoriously inaccurate.


The hope is that if DirectAssure is widely adopted, it could significantly ease administrative burdens for both providers and insurers. That’s because insurers regularly call providers to get updates on credentialing information, a time-consuming process for both entities, particularly providers who are getting these calls from multiple insurers.

Also See: Four updated HIPAA transactions coming by mid-2016

DirectAssure is seen as an answer to new requirements in the past year by Medicare and Medicaid plans, to ensure directory information is accurate and being reviewed by providers; 26 states now require timely directory updates, says Atul Pathiyal, a managing director at the CAQH Solutions unit of CAQH. Multiple states also are pushing for better accuracy of information, and the National Committee for Quality Assurance is developing directory accuracy standards. “We believe providers are interested in having a simple way to meet requirements and stop getting calls from payers,” Pathiyal adds.

DirectAssure was tested in the summer of 2015 with strong provider participation. Now, nine insurers are participating in the initial launch, with other payers encouraged to join following the launch. The first nine are Aetna, Blue Cross Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna-HealthSpring, Horizon Healthcare Services, Kaiser Permanente and UnitedHealthcare.

Health plans share provider lists with CAQH, which is contacting providers using ProView via postal mail and email and asking them to add DirectAssure. Those not using ProView will be asked to sign up for both services. So far, Pathiyal says, about 400,000 have been contacted, and that number will rise as more plans participate.

For reprint and licensing requests for this article, click here.