Five Questions for Provider Data Experts on the No Surprise Act

by Claire Thayer, June 11, 2021

Recently, LexisNexis Risk Solution’s John Markoff, Senior Director, Provider Data Strategy and Laura Long, Vertical Solutions Consultant, Provider Data joined us in a webinar discussion on the new provider directory accuracy requirements that go into effect in January 2022.  We caught up with John and Laura on five key takeaways:

1. What are some of the common concerns with the No Surprise Act regulations that payers would want to be aware of?

John Markoff and Laura Long: 

• Can the payer outreach to all directory facing providers every 90 days?
• Initial accuracy of a payer’s database.
• Does the payer have ability to process changes from the outreach in a timely manner?
• How will downstream systems be impacted if a provider doesn’t verify, and they need to be removed from the directory?
• Can the payer outreach to all directory facing providers every 90 days?Initial accuracy of a payer’s database.Does the payer have ability to process changes from the outreach in a timely manner?How will downstream systems be impacted if a provider doesn’t verify, and they need to be removed from the directory?

2. Provider data is constantly changing, what are some of the key challenges you're seeing today?

John Markoff and Laura Long: 

It’s a challenge to maintain a high level of accuracy for data attributes that don’t have an authoritative source. Challenges stem from disparate systems, manual processes and out of date sources of data. Payers acquire companies, merge data assets and change systems over time. Resolving the issues that result from this require significant investment from IT, Operations, Data Governance and Provider Management.   

 

3. When evaluating provider data, what are the four key elements of quality?

John Markoff and Laura Long:

• Accuracy – Timely and Correct
• Timeliness – Providing updates in a timely manner
• Completeness – Depth and Breadth
• Governance – Ongoing maintenance and audit resolution

4.  Does this new legislation only impact government sponsored payers?

John Markoff and Laura Long:

This legislation is relevant for any provider listed on a member facing directory, regardless of product line.

5. What steps should payer organizations be taking now to be compliant with the new regulations by the 1/1/2022 effective date?

John Markoff and Laura Long:

• Payers need to start planning now to outreach to payers and ingest that data in a timely manner to meet the timelines presented in the Bill. 
• Conduct a third-party analysis of provider data within their system.       

If you missed this informative webinar presentation, No Surprise - Provider Data Accuracy Mandated, we invite you to watch the full On-Demand webinar video or short webinar re-cap video.