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Provider Directory Risk Report
How accurate is my provider directory?
For years, the gold standard for measuring provider directory accuracy has been phone call audits. However, calls are expensive, inefficient, and abrasive to already-burdened healthcare providers.
All the while, payers need to know how accurate their directories are and how well their directory improvement initiatives are performing.
Benefits of analytics-based scores over phone calls
- Affordable and efficient alternative to phone calls
- Reliable and objective feedback loop to data sources
- Reduce provider abrasion by minimizing phone calls
- Assess accuracy across your entire network
Is there a better way to assess directory accuracy?
Compare your directory data with other payers' data (published as part of the CMS Rule for Interoperability CMS-9115-F) to assess the accuracy of your directory.
"One potentially promising method is to use data analytics to compare health plans’ directories, many of which are available in machine-readable formats thanks to federal regulation ... this alternative to a “secret shopper” method or phone survey method for monitoring may offer efficiency and value in identifying inaccurate listings"
State Efforts to Coordinate Provider Directory Accuracy: Final Report
Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health & Human Services, December 2023
Use CMS-mandated data to assess accuracy
Defacto Health has developed a novel method to leverage directory data from 125+ CMS-mandated Payer Provider Directory APIs to produce consensus scores on directory records.
This makes it possible to efficiently assess payers’ provider directory accuracy. This method has been validated with payers’ real directories and with phone call audits as a reliable way to assess directory accuracy.
Benchmarking Accuracy v. Other Payers
How we produce a risk report for your directory
Step 1: Query data from your organization’s Provider Directory API.
Step 2: Compare your directory data with all payers’ data to assess a directory-wide accuracy score.
Step 3: Benchmark your directory’s accuracy relative to other payers in the same market.
Step 4: Identify provider organizations that are contributing the most errors to your directory.