Who is Accountable for Inaccurate Dental Provider Directories? The Answer May Surprise You.

Spurred by consumer complaints, federal and state legislation will now require Payers to make a concerted and demonstrable effort to keep dental provider directories up-to-date. However even though Payers are tasked with making sure provider data in their directories are current and correct, the trickledown effect on providers is expected to be significant.

Implications to Providers

The passage of new federal and state directory laws mandating that Payors keep directories up to date are causing spikes in requests to providers for directory information and inaccurate directories can erode patients’ trust and result in lost revenue.

Patients won’t be concerned with the legal distinction of who is accountable for inaccurate directories. When patients receive surprise “out of network” bills, or show up for services to discover that their insurance isn’t accepted, or a provider who was plainly listed in the payer’s directory doesn’t practice there, it’s likely that word will spread about such experiences. It’s also likely that the patient won’t return even if the practice at some point accepts their insurance.

DSOs in particular are now finding it difficult to stay in in front of this issue due to the sheer volume of payers’ requests for updated directory data. Fulfilling numerous requests will prove extremely challenging and costly. And if payers don’t hear back from a provider, they’re likely to keep inaccurate data on the directory or even drop the provider from the network. Providers may not discover that the latter has happened until the stream of denied claims start arriving.

A single location practice may find it difficult to maintain directory data if their provider data is scattered across different files and folders, therefore imagine the challenges DSOs will be up against if their facilities rely on different processes to field Payors’ requests. Both scenarios are representative of how the task of keeping provider directory information up to date may prove costly and burdensome.

Information on Provider Directory Legislation

  • Directory information being requested
  • Federal Guidelines
  • State Guidelines
  • CMS Guidelines 
    • Network Adequacy and access
    • Real-Time Directory updates
    • Monthly Provider Contact
    • Online Provider Directory Content

What can DSOs do?

DSOs should take decisive action to efficiently and cost effectively improve how they maintain and share dental Provider directory information with Payers. The result will be a healthier bottom line while preventing financial stress for patients who often times already dread going to a dentist.

A DSO Can Establish Or Leverage Its Existing Central Repository For Storing And Managing Its Provider Data And Payer Affiliations.

Centralizing Provider data management would yield benefits that include:
  • “one and done” on collection of Provider directory information to eliminate manual effort for multiple requests
  • Automating fulfillment of Payors’ requests for directory updates according to Payor specific forms and file formats
  • Improving communications between Payers and DSOs over requests for Provider directory updates
  • Simplify management, maintenance and monitoring of provider directory data along with enrollment and credentialing data
  • Automate tracking of interactions and communications with Payors on requests for directory updates