Money & Business

America's Health Insurance Plans to Test New Provider Directory

By / Mar 28, 2016 (iStock/Thinkstock)

A major trade group for health insurance providers is developing a new program to provide families with accurate information about plans.

Choosing a healthcare provider can be maddeningly complicated. Lost in a sea of legal concepts and out-of-date information, many consumers fall into a plan that is not suited to their needs. America’s Health Insurance Plans (AHIP) hopes to combat this problem with a new directory program, which will launch next month.

The program will test two platforms in order to develop a unified system to improve how providers gather and release information about their plans—in an effort to improve what is now a pain point among consumers.

“[N]ot all providers rely on the same method of communication,” AHIP writes in a FAQ on the partner directory. “This often leads to delays in updating pertinent provider information.”

The two systems to be tested are Availity and BetterDoctor. While both are designed to provide a platform for provider information, there are slight variations in the way they operate.

To test the pilot versions of these directory systems, AHIP has partnered with 12 health plans from commercial, Medicaid and Medicare markets in Indiana, California, and Florida.

As part of the main initiative, participating providers will be required to update specific information, including contact information and specialty and hospital affiliations, according to the project’s FAQs [PDF].

Although both systems will use phone calls and emails to encourage providers to validate recorded information, BetterDoctor will rely on aggregated data while Availity will contact providers already in its portal system.

AHIP believes a unified directory is the best way to help consumers and providers alike.

“Consumers benefit when they have the information they need to make the best decisions about their coverage and their care,” AHIP President and CEO Marilyn Tavenner explained in the news release. “This latest pilot effort is designed to proactively address gaps in reporting in order to improve the experience for consumers and simplify the process for providers.”

After the initial trial period ends in September 2016, AHIP will conduct an independent evaluation based on feedback from providers and consumers, “with the goal of identifying best practices and joint solutions for improving data reporting.”

Although they are unsure of how well these proposed systems will work, both AHIP and the participating providers are eager to attack the problem head-on.

“It’s imperative we get accurate information to consumers on their providers,” Paul Markovich, CEO of Blue Shield of California and head of the new project told Healthcare Payer News. “We recognize that it takes both providers and health plans to make this work … to provide a single stop to update this information.”

Eli Zimmerman

Eli is studying Journalism at the University of Maryland. When not studying, he likes to relax with a nice book or a couple rounds at the local boxing gym. More »

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