CAQH attempt aims to clean up insurer’s contributor directories

A latest initiative targets to make better the quality of contributor information in health policy directories, which could importantly ease administrative burdens for both contributors and insurers.

CAQH is beginning the initiative, building on its products already in the marketplace. More than 1.3 million contributors already utilize the CAQH ProView credentialing database to report professional profile data to insurers, contributor organizations and other entities like regulators.

Now CAQH has started DirectAssure, a new module in ProView enabling contributors to consider and update their self-reported professional information. The attempt is intended to make better health insurers’ contributor directories, which customers use to find physicians who are accepting new sufferers; although, these directories simply are notoriously false.

The expectation is that if DirectAssure is immensely adopted, it could importantly ease administrative burdens for both contributors and insurers. That is because insurers regularly call contributors to get updates on credentialing information, a time-consuming procedure for both entities, specifically contributors who are getting these calls from various insurers.

DirectAssure is analyzed as an answer to new needs in the past year by Medicare and Medicaid policies, to ensure directory information is precise and being considered by contributors; 26 states now need timely directory updates, claims Atul Pathiyal, a managing director at the CAQH Solutions unit of CAQH. Multiple states also are pushing for better precision of information, and the National Committee for Quality Assurance is establishing directory accuracy standards. “We believe contributors are interested in having a simple way to meet needs and stop getting calls from payers,” Pathiyal adds.

DirectAssure was tested in the summer of year 2015 with powerful contributor participation. Now, 9 insurers are engaging in the initial launch, with other payers encouraged to join following the launch. The first 9 are Aetna, Blue Cross Blue Shield of Michigan, BlueCross BlueShield of Tennessee, Blue Cross and Blue Shield of North Carolina, CareFirst BlueCross BlueShield, Cigna-HealthSpring, Horizon Healthcare Services, Kaiser Permanente and UnitedHealthcare.

Health policies share contributor lists with CAQH, which is contacting contributors utilizing ProView through postal mail and email and inquiring them to add DirectAssure. Those not using ProView will be inquired to sign up for both services. So far, Pathiyal states, about 400,000 have been contacted, and that number will increase as more policies participate.

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