Health plan provider directories provide a crucial link between the plans themselves, the providers included in their coverage plan, and the customers enrolled in that health plan.
When these provider directories are inaccurate or not-up-to-date, they can cause problems for members of that health plan – and for the plan itself. This is because, if a member calls an inaccurate phone number, receives a surprise charge, or drives to an incorrect address – they can and often do complain to the Centers for Medicaid Service (CMS). In turn, these data inaccuracies that lead to member complaints, can lead to CMS sanctions and fines, a lower plan Star Rating, and a loss of federal funding.
Last year, even more regulation around the updating, editing, and distributing of directories came down from the CMS, in an attempt to keep government-sponsored plans in-line with CMS-mandated timelines and provider directory update requirements. Perhaps the most challenging among these, a requirement that printed provider directories need to be updated and provided to members who request them within 30 days.
While most health plan members receive their provider information online through emails or an online portal, many still prefer tangible, physical directories. And because the timelines surrounding the creation and distribution of directories, in all forms, are so strictly regulated by the CMS – producing them in an accurate and up-to-date manner can be problematic for plans. However, there are print-specific actions that health plans can take to stay ahead of these difficult regulations, with one such strategy represented by geocoding.
What is Geocoding?
A simple geocoding definition would be the following.
Geocoding by zipcode is a technology-based way of increasing the accuracy of enterprise location intelligence. Built off geocoding databases of addresses that are carefully validated and standardized to help maintain accuracy, geocoding assigns latitude/longitude coordinates to addresses, making it easier for enterprises to integrate changing location information with their other customer data. But there’s another benefit, as well.
Geocoding benefits include the fact that it can make print-on-demand programs much more cost-effective. Here’s how.
For a health plan struggling to keep up with high, monthly print-on-demand (POD) costs due to reprinting and redistributing printed provider directories to the entirety of their customer base, utilizing a customer communication management (CCM) solution that incorporates geocoding of addresses can be game changing.
What geocoding means, when built into a print-on-demand workflow platform, is that health plans can map a radius around their member’s zip codes, and only reprint and distribute directories to patients that request them or those that are most affected by changes. It’s a way of leveraging customer data that makes reprinting and distributing provider directories more convenient for both the health plan, and member. For example, say a plan that serves five counties was utilizing an integrated CCM/POD solution such as Novitex CONNECT.
If changes that need to be updated and reflected in reprinted directories only occurred in Geographic Zone A in the past month, then, those patients in Geographic Zones B, C, D, and E, would not need updated directories, and the plan would have the ability to forego printing them. But, still are able to have them available if requested. Those, in essence, are the geocoding benefits.
By breaking down a customer base geographically using geocoding batch technology, health plans can print less pages which can save money, and members can get more targeted directories that only include providers that are within their specific geographic area – which creates a more streamlined, positive customer experience, and ideally, keeps complaints down and Star Ratings up.
How it Works with Healthcare CONNECT
Healthcare CONNECT is an end-to-end document creation platform that health plans can use to create personalized documents from a single, custom online dashboard. With the geocoding technology that is incorporated into the platform, we can help create directories that are very granular - down to as small an area as a single mile radius, which can help connect patients with providers who are very easily accessed from where they live. And which also makes the on-demand printing that health plans need to update these plans more cost effective through increased accuracy, cutting down on edits and reprints.
Here’s how it breaks down, in terms of some geocoding basics.
The integrated geocoding technology utilizes member zip codes to guide provider selection for each member. This data is refreshed monthly, which can improve overall directory accuracy. This increased accuracy helps minimize issues like over-ordering of materials for printed directories, and this type of refined print on-demand cuts down on warehousing of old or outdated materials as well.
When accurate geocoding and print-on-demand services are incorporated with this type of holistic communication creation engine, there are sizeable pain points that can be alleviated. Some the challenges addressed include an inability to streamline provider directory edits or updates, difficulty keeping up with CMS regulations and monthly audit requests, and slow processing times.
The CMS regulations surrounding printed provider directories are a tall order – no matter which angle you consider the task from. But, by incorporating strategies like geocoding, print on-demand, and end-to-end document creation, approval, and dissemination platforms – health plans can successfully navigate these tough regulatory conditions, and provide a high-quality customer experience along the way.