Complying with the No Surprises Act isn’t anything new for healthcare payers. You’ve been working, planning, and preparing for it since the act was signed into law in 2020. But when the law was enacted earlier this year, healthcare payers faced new challenges.
One area that proves difficult is updating and validating provider directories – and rules governing the speed at which these updates must happen. Intended to help members avoid unexpected medical bills by making sure directories are current, the rules seem simple enough. But as payers know, the effort required to stay compliant is anything but simple.
Tighter deadlines and larger workloads mean payers need new tools to meet new regulations without overburdening already busy staff. Technology is one tool many payers use to stay compliant and improve their efficiency.
Tighter deadlines, larger workloads
When a patient needs care, the first stop is often their insurer’s provider directory to find in-network providers. But when CMS reviewed the Medicare Advantage directory, they found that over half of entries (52%) had at least one error. In a subsequent survey, the review found over 48% of the locations listed had at least one inaccuracy.
An out-of-date directory means that a patient might accidentally select a provider that is no longer in the network. This can translate to unexpected bills, especially if the member signed a Surprise Billing Protection Form consenting to treatment, and costs, from an out-of-network provider. This is a huge stress to patients, with one in five insured adults reporting a surprise out-of-network medical bill and two-thirds saying they’re worried about unexpected medical bills. Keeping the provider directory current allows members to make informed choices about which providers to see and how much it will cost.
Of course, health plans also want to keep these directories updated. With providers constantly moving and changing addresses, the volume of changes can be significant. In the past, health plans had up to five business days to process directory updates once notified of a change. Now, updates need to be made faster than ever. The No Surprises Act condenses the time from five down to two business days – cutting processing time by more than half. The shortened time frame puts more pressure on already busy staff. When updates are processed manually, the risk of human error increases.
And if processing provider updates faster wasn’t enough, health plans also need to complete a directory verification for all providers every 90 days. Performing this verification might involve receiving data through multiple channels – email, web forms, or even fax and phone calls. Maintaining compliance without losing efficiency requires health plans to lean into technology to lessen the load.
How technology eases the burden
You’ve worked hard to create processes and resources for managing provider updates and verification requirements. You may handle the task internally or outsource some or most of the validation tasks.
If you’re managing parts of the process internally, technology helps reduce that burden. For example, maybe you’re outsourcing the manual provider outreach, but you continue to log and track responses in-house. If so, electronic process workflow technology can help.
Electric process workflow automates the flow of electronic content to make it more efficient. This type of technology helps track the responses you receive, so you can not only document and prove timely compliance but can also flag responses that may need follow-up. If a provider has moved, for example, the technology can identify that additional action is required.
If you’re handling verification manually, an electronic workflow process can help you offset the workload. For example, you might send a single electronic form to all providers showing their current data. The technology asks them to check if the information is correct or needs an update. If an update is required, the data collected is imported into your provider database and / or an appropriate staff member is notified.
The goal of the technology is to free your employees to focus on higher-level work by automating the tasks that are easy to automate. Plus, delegating what are often mundane tasks to technology helps improve satisfaction levels while also improving accuracy and timeliness.
Staying compliant and efficient
Healthcare payers took on a massive task to move into compliance with the No Surprises Act. Already, you’ve done an immense amount of work. But as you know, just because you’re compliant doesn’t mean you’re operating as efficiently as you could be. Technology helps close efficiency gaps and remain compliant—all while reducing the burden on your internal resources.