CAQH White Paper Calls for Industry Collaboration to Solve Provider Data Challenges
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"The poor quality of provider data has created one of the most pressing challenges in this era of healthcare reform," said CAQH Executive Director
Healthcare provider data forms the foundation of many important processes in the nation's healthcare system. This information is necessary to conduct a number of essential functions, such as referring a patient to a specialist, paying insurance claims, determining provider sanctions and credentialing providers. For example, the highly-publicized findings around inaccurate information found in health plan directories demonstrated the potential that unreliable data has to cripple everyday interactions between providers and health plans.
Obtaining accurate, timely provider data has long been an issue within healthcare. New market and policy forces, including those driven by the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act, have put additional pressure on the industry to resolve the problem, according to the white paper. The increase in the number of health plan products developed for healthcare exchanges, as well as additional regulatory reporting requirements for health plans and healthcare providers, require new data elements and formats. In the absence of an industry-wide "source of truth," stakeholders have developed highly individualized approaches to maintaining data, which has led to redundancy across the industry. One analysis cited by the paper estimated that commercial health plans and providers alone spend at least
While the job of collecting and maintaining provider data may appear straightforward, the white paper details many of the complexities. Pain points include a lack of reliable sources of data, standard definitions of providers, quality benchmarks and accountability measures. Since there is not consensus on an authoritative source for provider data, organizations have historically defined their own standards and processes for collecting data, perpetuating costly, redundant systems. The very definition of "provider" has shifted with the increase of healthcare teams, and naming conventions for many professionals remain inconsistent. Finally, there are no widely adopted measures for what constitutes "high-quality" provider data, and little consensus on how both data producers and users can be held accountable for their roles.
CAQH developed the white paper in collaboration with
Keywords for this news article include: Managed Care,
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