LexisNexis® Risk Solutions announced that it is assisting the health care market address recent federal and state regulatory requirements tied to provider directory accuracy through its LexisNexis® Provider Data Intelligence Suite.
Inaccurate or missing provider data negatively impacts compliance, member and provider relations, as well as other critical work streams. LexisNexis health care internal analysis has found that when factoring in administrative activities to correct the errors, customer satisfaction, return mail, fines, penalties or other sanctions, such as directory requirements from the Centers for Medicare and Medicaid Services and state agencies, bad provider data costs the U.S. $23-26 billion per year.
New, tougher mandates, such as the Federal Exchange, Medicare Advantage and Qualified Health Plan Directory Data Requirements enacted in 2015, pushes health care organizations to maintain accurate provider information. Stipulations for compliance include giving providers a means by which they can self-attest their information by plan in which they participate. Penalties for non-compliance can be severe. In the case of Medicare Advantage directories, the penalties stipulate inaccuracies may trigger penalties of up to $25,000 per day per beneficiary or bans on new enrollment and marketing.
LexisNexis is shifting how the market approaches provider data quality and maintenance by providing a systematic method for plans to proactively address the demand for accurate provider data information with its Provider Data Intelligence Suite. The suite provides a continuum of data assets, real-time validation, agile data management and technology-enabled phone validation, as well as a portal through which providers can attest their information. This robust offering helps alleviate the administrative burden for plans allowing them to focus on caring for their members.
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