Tennessee insurers seek to improve provider data

Three healthcare plans in Tennessee have joined an effort to improve the accuracy of provider data submitted to insurers.

The plans are getting help from CAQH, a healthcare stakeholder organization that works with providers and payers to improve business processes.

BlueCross Blue Shield of Tennessee, UnitedHealthcare and Amerigroup of Tennessee are using the CAQH ProView software to self-report professional and practice information so patients can find providers who accept their insurance, get other information such as providers’ office hours, days in the week that the provider is in the office and whether a receptionist is available in the office, and receive the care they need.

Also See: Pharmacy refill data helps providers detect medication non-adherence

But getting clean, accurate and updated data from providers has always been a struggle for insurers, says Atul Pathiyal, senior vice president at CAQH.

For example, a provider organization may have 10 sites with the doctors working at various sites, and the provider may send all of its data from only one or two locations, so providers at the other locations may not show up in the provider directories.

Now, the Tennessee insurers will adopt CAQH’s ProView software, which is a tool that provides directory services, claims administration and the cleaning of provider data to speed data collection, support credentialing of providers, and distribute the provider data to the appropriate health plan.

“This essentially is a one-stop shop for the provider, and the tool is free for providers to use,” Pathiyal explains.

In total, Tennessee has about 20,000 doctors and 50,000 total providers such as nurses, social workers, home health agencies and other ancillary providers.

Across the nation, about 1.4 million stakeholders use ProView for provider updates. In Tennessee the three insurers have come together to educate providers on the ease of directly submitting data to ProView to clean and send to insurers.

The health plans also are working with CAQH to replicate the Tennessee program nationally, according to Pathiyal. “The solution is available and we’re looking for other payers to align and solve this problem on a national scale.”