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Directory Accuracy and Network Adequacy as a Strategic Initiative for Healthcare Payers

Cate McConnell
May 18, 2017

When you're looking for a new physician, besides looking for a quality healthcare provider, most people are in search of someone who is within their health insurers network to ensure they won't pay more out of pocket than necessary.

So what if you did your due diligence as a patient, searched for a covered provider with quality reviews, and then received a bill you weren't expecting saying that provider was, in fact, not in-network?

Unfortunately, this isn't a rare case for many health insurance members, and with members' mounting frustration, also comes the pressure on insurers to provide a real-time, constantly updated, online directory of their covered providers in order to prevent this. Especially now, in a new age of choice within healthcare, members have an easier path than ever to switch to a different insurance company should they encounter issues like this.

It's not just member demands that are making online, up-to-date network directories a priority either; insurers can face hefty fines from the Centers for Medicare and Medicaid Services should they not have an accurate provider directory.

The big question many of these insurers face now though is, how do we move forward with finding the right IT solution in order to make this happen?

That's where digital transformation can help.

Jeff Rivkin, IDC Research Director, recently spoke at Appian World 2017 about how insurers can best serve their members using digital transformation. Rivkin discussed the importance of providing the highest quality of service in order to both retain current members, and attract new ones. Members of the Appian Community can listen to a recording of the session here.

Following up on this presentation, Jeff wrote an analyst report that provides an in-depth view of how digital transformation can assist insurers in preventing fines, increasing member loyalty, and streamlining their work with providers.

Check out that report, found here, on Appian's website, and once you've given it a read, let's set up a time to chat about how digital transformation can help you provide your members with the highest quality of service. Contact me todayand we'll put it on the calendar.