The challenge of keeping provider data correct drives improvement initiatives

In 2016, a research group at West Virginia University had a team of secret shoppers pose as patients. They tried to make appointments with 743 primary care physicians listed in the company’s provider directory. They were successful only 30 percent of the time.

Keeping provider data consistently accurate is a challenge for everyone. Demographics, affiliations, locations and specialties change continually. Studies have shown that:

• 2.4 percent of provider demographics change each month
• 30 percent of doctors change their affiliations each year
• 5 percent of doctors change their status each year

In a review of Blue Cross Blue Shield of Michigan’s provider data, we found that many provider groups have more than three locations for a single provider.

As part of our data model, we require one primary location for each group that a provider is affiliated with, regardless of how many addresses there are for that group. Non-primary locations should only be added if patients can make an appointment at that location.

About our data quality improvement initiatives

Over the past two years, Blue Cross Blue Shield of Michigan and its Physician Group Incentive Program’s physician organizations have partnered on programs that improve provider data quality and, subsequently, patient satisfaction when using Find a Doctor.

Our Provider Data Directory Quality program rewards physician organizations for keeping up-to-date provider data. Accuracy results have increased 14 percent overall to an average 68 percent since data quality was assessed in 2017.

Other quality initiatives include the recent pilot of CAQH Direct Assure 2.0, a tool to reconcile CAQH provider data with data in the Blue Cross system. Preliminary results show that alignment has improved by more than 30 percent.

Blue Cross also routinely performs internal analyses on provider data to identify non-essential or non-appointing address data that displays in Find a Doctor.

Room for improvement

While we have many data quality improvement initiatives, we still have a long way to go. We’ve discovered that our non-primary provider location data is out of date and only about 40 to 50 percent accurate.

Over the next few months, we’ll be reviewing data and cleansing non-primary locations. Once complete, you’ll be able to:

• Focus on your primary provider locations.
• Start with a clean slate for non-primary locations.

Rest assured, removal of locations because of this cleanse won’t affect any claims payments.

Playing your part

To improve our data, please continue working with us to keep your demographic information up to date. Use the Provider Enrollment and Self-service tool to make any necessary changes and use CAQH ProView to verify that CAQH has correct location information for you.

While making updates, keep these pointers in mind:

• Minimize the number of locations added for each provider so they’re easier to manage.
• If primary locations for providers don’t take appointments, don’t display them in the directory.
• Additional locations shouldn’t be added to the provider’s profile unless they’re appointment addresses.
• When making CAQH location updates, don’t forget to add the Type 2 National Provider Identifier (NPI 2) and Taxpayer Identification Number.

If you have any questions about the information in this article, reach out to Sarah Aly, Team Leader II, Provider Ops & Innovation, at saly@bcbsm.com.