This is an AArete Healthcare Payer solution

Situation

According to the Centers for Medicare and Medicaid Services’ (CMS) audits of Medicare Advantage online provider directories, more than 50% of entries have at least one inaccuracy. Expecting the most accurate data possible, a multi-state health plan partnered with AArete to migrate their provider demographic data from their existing legacy platforms to corporate platforms for Medicare and commercial lines of business.

Approach

AArete collaborated with plan, corporate IT and local IT teams to restructure the provider data by reformatting and filling in missing elements required for the PDM system. AArete also audited the demographic data to be used in the PDM system and Find-A-Provider and print directory, as well as submitted the files that met corporate requirements for data upload, and remediated fallout reports to complete the data migration.

Results

After a thorough auditing and clean-up migration process, results included:

• An updated Medicare network data in corporate PDM systems to reflect directory demographics, including:
  • 37K Medicare address enrollments
  • 200+ ancillary/hospital Medicare address enrollment submissions
• A defined commercial network and migration to corporate PDM, including:
  • 1.4K TINs enrolled for commercial networks
  • 37K legacy records for commercial practitioners enrolled in PDM based on directory data
• Development of source documentation for migration, including:
  • A central reference document for commercial-only providers
  • A compiled data dictionary based on information requirements for commercial-only enrollments

Source: CMS Online Provider Directory Review Report

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