Press Releases

New HealthSparq Clean Helps Health Plans Avoid Costly CMS, State-Level Fines for Inaccurate Provider Directories

HealthSparq Clean is tailored to ensure health plans get accurate data needed from providers to achieve compliance and dramatically improve member experience

PORTLAND, Ore. – October 29, 2015 – HealthSparq announced its new data-as-a-service offering HealthSparq Clean today, a program that helps health plans correct the inaccuracies in their provider databases and establish ongoing updates. Unlike any solution on the market, HealthSparq Clean is designed to help health plans avoid significant fines from the Centers for Medicare & Medicaid Services (CMS), while giving members a directory they can trust.

Recent studies indicated that provider directory data is inaccurate and outdated by as much as 50 percent. Patients rely on provider directories to find doctors who are in their network and accepting new patients, among other things, and inaccurate directories can lead to patients ultimately shouldering a much higher portion of the cost of their care. As a result, CMS is requiring health plans to continuously update provider directory information in real-time beginning January 1, 2016, with many states enacting their own mandates and fines.

To avoid fines as high as $25,000 for each individual inaccuracy found in a directory, health plans can use HealthSparq Clean to establish a structured and proactive process to ensure compliance with all of the disparate CMS, state-level, and pending Affordable Care Act (ACA) regulations and mandates.

The solution can do the following for health plans:

  • Contact providers’ offices directly – including by phone – to obtain any information required to list in a directory (in-network status, current contact information, new patient acceptance status, all locations for the provider, etc.). ** This also includes identifying the right person in an office to provide this information on an ongoing basis, as it is often not the provider him or herself.
  • Create an automated outreach program that obtains and updates this information at regular intervals – while managing the operation costs through automation – as requested by the plan to meet mandates (at least monthly per CMS guidelines).
  • Gathers all of the above data in whatever format the health plan wishes to receive it to meet their current (or future) database structure.
  • Delivers this data via a sophisticated, tailored, and secure portal.

“What CMS is asking of health plans isn’t easy. It’s going to take tremendous effort for them to meet these mandates, especially considering that some mandates have not been fully defined,” said Dan Medin, service products director for HealthSparq. “We’ve designed this service to be as tailored and nuanced as possible so a health plan in California can meet both CMS and its own strict state guidelines, and a health plan in New York can do the same, all without having to redesign their directories or create a custom solution.”

Click here to learn more about HealthSparq Clean.