Validating national provider identifier

All users have the ability to inform us of requirements which they believe would make their daily tasks easier.This feedback is formally documented and after discussions with the AT-Learning Technical Change Control Board, all requirements are prioritised and then go into development.Typically, provider enrollment, provider contracting, credentialing, and claims processing are in different departments and systems, often without clear data ownership or consistent processes for updating and correcting directory entries.This problem is often exacerbated by the lack of a “process owner,” someone who is accountable for the governance, business rules and, ultimately, the quality of the provider data used throughout the enterprise.Regulators are responding to consumer frustration by calling attention to those health plans who struggle to manage their provider network databases.The latest rules from the CMS shouldn’t come as a surprise.In other words, it’s time to fix this problem, and to get it right as an industry.That might mean revising our business processes or rethinking the way we use technology to support our processes.

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What was once an annoyance and embarrassment is now being treated with increasing scrutiny and suspicion.Consumers can’t make well-informed choices about their plans and providers if the information they get from payers is in error or out of date.The chaos and increasing risk in the system has three causes: organizational, technological and industry complexity.They were announced in draft form last February, and are now in effect as of January 1st.CMS also specified that payers offering federal exchange plans could face penalties per day per affected beneficiary. State governments, such as New York and California, are penalizing health plans who fail to provide accurate provider information to consumers.

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