BETHESDA, Md., July 18,
2024 /PRNewswire/ -- Incorrect data in health plan
physician directories is a pervasive problem, according to new
research conducted by researchers at University of Colorado and HiLabs. The study,
published in BMC Health Services Research, leverages HiLabs
AI algorithms to compare data for >40% of US physicians across
five large health plan directories.
Researchers found little variation across insurers in quality of
information on physician addresses (72%-83% inaccurate), phone
numbers (73%-84% inaccurate), or specialty (32-36% inaccurate). The
level of inaccuracy was also noticeably high when comparing against
the Medicare Provider Enrollment, Chain, and Ownership System
(PECOS) database, which is widely regarded as the gold standard for
provider data. States with more laws targeting this issue did not
have better data quality.
Incorrect provider directory data can lead to delays in care,
surprise billing, and challenges for consumers selecting health
plans. The 2021 No Surprises Act contains requirements for insurers
to keep their directories up to date. The REAL Health Providers
Act, currently pending in the US Senate, proposes additional
regulations for insurers to improve directory information,
particularly for mental health providers. Notably, this new study
found that physicians specializing in psychiatry or neurology had
correct addresses only 28% of the time and correct phone numbers
only 16% of the time, and no physician specialty had correct
addresses or phone numbers >50% of the time.
"These results demonstrate that no insurer has solved the
provider data problem," said Dr. Neel Butala, Assistant Professor
at University of Colorado and lead
author of the study. "They also suggest that legislation targeting
insurers to improve directory accuracy has not been successful and
that creation of a singular national provider directory, as
recently proposed by CMS, may prove challenging."
"We are proud to collaborate with University of Colorado researchers to use our AI
for this important study," said Amit
Garg, CEO of HiLabs. "At HiLabs, we have seen tremendous
interest from health plans in using AI algorithms to uncover
provider directory inaccuracies in recent years and have seen
substantial improvements in directory accuracy as a result."
For further information and to access the full study, please
visit https://doi.org/10.1186/s12913-024-11269-5
About HiLabs
HiLabs is a leading provider of AI-powered solutions that clean
dirty healthcare data. HiLabs is committed to transforming the
healthcare industry through innovation, collaboration, and a
relentless focus on improving patient outcomes. For more
information, please visit hilabs.com or contact
info@hilabs.com.
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SOURCE HiLabs