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The Centers for Medicare and Medicaid Services (CMS) is aiming to construct a healthcare resource that has been notoriously difficult to create: a national provider directory. For decades, policies attempting to hold managed care organizations responsible for keeping up-to-date directories of their in-network physician practices, hospitals, surgery centers, and the like have been impractical for insurers to comply with and nearly impossible for policymakers to enforce. Reports of error-filled “ghost networks” that misrepresent the real-world provider network have consumer advocates demanding better solutions through legal action. Federal law currently requires insurers to verify their provider directories every 90 days or face financial penalties. Meanwhile, providers don’t always have an ideal channel to notify their insurance partners of directory updates in real time. CMS is hoping a national directory will ensure stakeholders can “all work from the same map.” Even with sophisticated digital technologies, keeping up such a massive list could be a Herculean task, according to observers speaking to Modern Healthcare.
Quick search for urgent care: ”One of the advantages of contracting as an urgent care center is inclusion in payer directories when patients search for ‘urgent care,’” says Alan A. Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM. “Otherwise, primary care and specialist providers are often listed under the provider name and not the name of the facility. I encourage providers to verify their listings in each payer directory on a regular basis. Until a single, national source of truth is established, searchable by participating health plan, many patients and providers will continue to rely on nonpayer, third-party directories that optimize Google search.”
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