Is Your Provider Data Ready for CMS Submission?
While Americans are preparing for the fast-approaching April 15 IRS tax filing deadline, Payers are readying for CMS Medicare Advantage (MA) filing through the Health Plan Management System or HPMS. Starting with the Notice of Intent to Apply (NOIA) up until the final bid submission deadline in early June, as part of the application process, payers must attest to service area requirements. This includes having a contracted network in place and credible processes for monitoring and maintaining the contracted network to meet current CMS MA access to services requirements and network adequacy standards.
Does your health plan have a road map for a successful network submission, or will the road be another mad scramble to the deadline with fingers crossed that everything will come together on time? A subpar network build is just too great a risk to success in your target market. Improving provider network data is crucial to mitigating the risk of missing the mark. A few considerations:
Collaboration and Education – Easing Collection of Information from Providers
How well does your health plan work together with providers and other stakeholders to create work standardized processes for data sharing and management? Initiatives like universal rosters for credentialing can significantly reduce redundancy.
Are your network forms concise and reduce requesting redundant information?
How easy is it for providers to submit the information (fillable PDFs or better yet an online portal to complete and upload information)?
Do the forms contain all the necessary information needed to meet the CMS filing information requested?
How often do you provide resource information, education, and training to help providers understand the importance of keeping their information up-to-date and how best to provide to the health plan?
Easing the provider’s administrative burden to provide information will go far in building the provider-payer relationship. It lays the foundation for building trust with members, providers, and regulatory bodies, enhancing the overall reputation of you - the payer.
Investment in Technology
Is provider data process improvement a part of your annual goal setting plan? Health plans need to continually assess the availability of advanced technologies, such as automation and AI, to streamline data management and ensure accuracy. The investment in technology will pay off over time in reducing claims payment errors, improving provider and member satisfaction, and reducing costs associated with data clean-up projects.
Communicating Across all Teams the Importance of Collecting, Enrolling Credentialing, and Publishing Accurate Provider Data
Within the payer/health plan organization, it is important to communicate across relevant teams the CMS provider data requirements. Up front communication will help avoid last minute network changes, missed opportunities, and poor provider directory outcomes. Have a clear project plan that is reviewed at regular intervals to incorporate messaging to key staff/relevant teams. It is important to share points about network filing, the CMS rules, best practices, and other obstacles that may stand in the way of a successful network filing.
Complete Provider Information Leads to Better Network Analysis
Accurate network information is crucial for the smooth functioning of the healthcare system. It also allows payers better insight to analyze and optimize their provider networks effectively, identifying gaps and areas for improvement.
Accurate Provider Directories Can Improve Member Enrollment Outcomes
Following a successful CMS application approval, there is a short time frame to finalize the provider directory for member enrollment. Up-to-date network information ensures that members have access to accurate provider details, leading to better service and satisfaction. And overall, it can improve member enrollment outcomes.
Use of External Data Experts to Gather, Compile, and Cleanse Provider Data
Engaging external data experts can significantly elevate the quality and efficiency of provider data management. These specialists bring a wealth of knowledge and advanced tools that can ensure data accuracy, completeness, and compliance with industry standards and regulations. By leveraging their expertise, organizations can avoid the pitfalls of outdated or inaccurate provider data, leading to better decision-making and enhanced network performance. Moreover, outsourcing this critical function allows internal teams to focus on strategic initiatives and core business activities, optimizing resource allocation and reducing operational costs. In essence, collaborating with external data experts is a strategic move that fosters a more robust, reliable, and compliant provider data ecosystem.
Application
The Viability Company developed a stream-lined approach to sourcing and validating hospital services data for a national payer. This ensured the data was accurate and complete, giving the payer a competitive edge and confidence in their CMS filing. In another case, The Viability Company collaborated with a payer to analyze an existing network target list to review the data for accuracy and completeness. This thorough review enhanced the payer’s contracting team outreach by identifying provider affiliations with groups and systems, while also eliminating redundant and outdated provider data from the target list.
Partner with The Viability Company to harness our expertise and achieve your provider network goals! For further information contact Deb Burnham, Principal, at dburnham@viabilitycompany.com.