Using Provider Directory APIs to identify errors in plan directories
“One potentially promising method is to use data analytics to compare health plans’ directories, many of which are available in machine-readable formats
Author: Ron Urwongse
HHS report considers the merits of centralized provider directories
In December 2023 the Office of Behavioral Health, Disability, and Aging Policy (within the US Department of Health and Human Services) published
State of Provider Directory APIs 2024
Background and Purpose of Analysis In July 2021, CMS required payers with CMS-regulated health plans to publish Provider Directory APIs. In the 3 years
Provider Directory API’s Supporting Role in the 2024 CMS Interop Rule
Key Takeaways: Re-Cap of the 2024 Rule Our previous post included a summary of the 2024 CMS Interoperability and Prior Authorization Final
A Review of the 2024 CMS Interoperability Rule through the Lens of Directory Use Cases
Yesterday, 13 months after proposing it, CMS finalized its Interoperability and Prior Authorization Rule. As CMS worked towards publishing this rule, payers,
The REAL Health Providers Act
Last week, the Requiring Enhanced and Accurate Lists (REAL) of Health Providers Act was introduced by Senators Wyden D-Ore., Bennet D-Colo., and
How payers can think about competition as network and price transparency expands
Regulatory Requirements on Network and Price Transparency Transparency-related federal rules are causing a seismic shift in the healthcare industry, compelling payers to
Payers are switching Provider Directory API vendors
Two years after the effective date of the CMS Final Rule on Patient Access and Interoperability, payers are reassessing their Provider Directory
Using Payer APIs to Improve Mental Health Networks
In our last article, we explored mental health ‘ghost’ networks as discussed in the May 3rd Senate Finance Committee hearing. We summarized
Understanding Mental Health ‘Ghost’ Networks
This is the first of a two-part series on mental health ghost networks. In the first post, we will assess the information