A new approach to sharing delegated provider data

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3/29/2019

GW Medical Faculty Associates in Washington, D.C., struggled with the process of sharing information about its providers with 15 contracted health plans. It had delegated arrangements with these plans, meaning the organization could provide a single roster containing information about all providers to each plan. However, each plan had different data requirements and schedules for roster submissions, which made managing the process laborious and fraught with errors.

Looking to simplify the credentialing process and more accurately share its provider data, GW began using CAQH ProView for Groups, a secure web portal that enables provider groups to submit a single roster of their delegated providers for all participating health plans. “We’ve found this new roster maintenance process from CAQH easier than the legacy process,” said Gloria Faniyi, credentialing specialist, GW.

CAQH ProView for Groups uses a standard format for enrollment, delegation oversight and directory maintenance, enabling groups to submit one roster to all participating plans the group authorizes. Although this roster requires more fields than some proprietary plan formats, Faniyi, for example, finds value in having a thorough dataset. She uses the CAQH ProView for Groups roster, particularly the location tab, as the “source of truth to check data” and for internal reporting. Faniyi has also sent the roster to her plans not currently using the CAQH solution because the data is comprehensive, and the process is easier.

A recent CMS audit concluded that provider directories are plagued with errors, with incorrect locations being the primary offender. According to the audit, 48.7% of provider locations listed in the directory included at least one inaccuracy.1 In an effort to increase directory accuracy, CAQH performs more than 120 data quality checks that prevent the most common data quality errors, such as incorrect information about locations, phone numbers or whether the provider is accepting new patients. The Groups module then auto-generates an error report, enabling the group administrator to fix inaccurate data before it is shared with plans.

Faniyi reports that her rosters perform well against the quality checks. The few errors the system found were easy to locate and fix.

Figure 1. Data exchange via a centralized portal

Groups can search for participating plans in the CAQH portal and authorize which plans have access. There is no cost for the group to participate. Plans can subscribe to provider groups and receive automatic notifications when new data is available. Faniyi appreciates the transparency of the process. “I like the fact that I can access old rosters and view the date and time the plan downloaded the new data.” Her workflow involves adding new providers before submitting the full roster to all authorized plans on the 15th of each month. She is able to copy and paste information directly from her provider data management system into the CAQH roster. Because CAQH ProView for Groups tracks updates between full roster submissions, Faniyi no longer needs to prepare and send interim change reports.

According to Faniyi, this addresses a major pain point for groups — slow and incomplete directory updates. “Previously, any changes to directory information we made, including terminated providers and inaccurate addresses, might not be reflected in online directories for months.” This lag has consequences for business processes and patient access. With a more efficient process, directories can now be more up-to-date and accurate.

Faniyi hopes that more GW delegated plans and other provider groups will realize the need for a centralized sharing model and begin using CAQH ProView for Groups.

“There is work involved up front to complete the initial roster, but after the first file, the process is much easier and faster,” said Faniyi. “CAQH assisted us with the initial roster creation and that accelerated the process.” Once the initial roster is complete, plans receive better quality data, specific to their plans, thus reducing the need for frequent phone calls or emails to provider groups.

“The more plans and groups adopting this system, the better it will work for everyone. I’m looking forward to having all plans on board and streamlining the process with one roster for all,” said Faniyi.

Given the increasing importance of accurate provider data, the need to improve the exchange of delegated data is a priority for groups. CAQH ProView for Groups is helping streamline the process to reduce administrative burden, improve data quality and increase transparency.