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Why Provider Directory Mandates Are Failing In Healthcare

Dec 13, 2024 - forbes.com
A study published in The American Journal of Managed Care highlights significant failures in healthcare administration, specifically regarding provider directory mandates. The research found that 40% of inaccuracies in provider directories persisted for an average of 540 days, far exceeding the 90-day federal update requirement. This issue poses serious implications for patient care, regulatory compliance, and healthcare access, as only a small percentage of inaccuracies are corrected, and many listings contain incorrect information. The traditional manual verification process is inadequate, especially given the volume of providers and health plans, and rural areas face even greater challenges, raising concerns about healthcare equity.

The study suggests that technology-driven solutions are essential to address these systematic failures. Modern platforms can leverage real-time data cross-referencing, artificial intelligence, and machine learning to predict changes, identify inconsistencies, and ensure accurate provider information. These technologies can automate compliance reporting and maintain data accuracy, reducing administrative burdens and improving patient care. The findings emphasize the need for a shift away from manual processes to technology-based solutions to meet regulatory requirements and patient needs effectively.

Key takeaways:

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  • Provider directory mandates are failing, with inaccuracies persisting for an average of 540 days, far exceeding the 90-day federal update requirement.
  • Manual processes for verifying provider information are inadequate, leading to significant barriers for patients and challenges in maintaining accurate directories.
  • Technology solutions, such as real-time data cross-referencing and AI, can improve accuracy and compliance in provider directories.
  • Inaccuracies in provider directories can exacerbate health equity issues, particularly in rural areas, and lead to delayed care and unexpected costs for patients.
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