Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Can your claims review resources maximize the turn around time needed for complex claims? CLICK HERE and let us show how BHM’s economically maintain turn-around times and accuracy for new members.

In its second round of online provider directory reviews, the Centers for Medicare & Medicaid Services found that 52% of the Medicare Advantage provider directory locations listed had at least one inaccuracy. 

Medicare AdvantageThose errors included providers who weren’t at the location listed, providers who didn’t accept the plan at that location, providers who weren’t accepting new patients despite the directory saying that they were, and incorrect or disconnected phone numbers. 

When CMS conducted its first review of MAOs’ provider directories, it found that 45% of locations listed were inaccurate. While the report does say that the first and second reviews aren’t directly comparable “due to minor updates to the review methodology,” at the very least, the latest review’s results indicate the problem isn’t getting any better. 

CMS also noted that its findings were not skewed by a few organizations but instead were widespread in the sample reviewed, which was about one-third of all MAOs. “Very few organizations performed well in our review,” the agency said. 

At a minimum, provider directory errors can make members frustrated with an MAO, the report noted. But they can also cast doubt on the adequacy and validity of the MAO’s network as a whole, and even more seriously, prevent members from accessing services that are critical to their health and well-being. 

Based on the results of its reviews, CMS has sent 23 notices of noncompliance, 19 warning letters and 12 warning letters “with a request for a business plan” to Medicare Advantage insurers. 

However, the agency emphasized that MAOs themselves “are in the best position to ensure the accuracy of their plan provider directories.” It also said it was encouraged by pilot programs aimed at developing a centralized repository for provider data that would be accessible to multiple stakeholders. 

In the near term, CMS added, MAOs should perform their own audits of their directory data and develop better internal processes for members to report errors. 

Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Can your claims review resources maximize the turn around time needed for complex claims? CLICK HERE and let us show how BHM’s economically maintain turn-around times and accuracy for new members.