Research into directories of UnitedHealth, Elevance, Cigna, Aetna, and Humana uncovers inaccuracies that can lead to surprise billing and delays in care.
Five of the largest health insurers have inconsistencies in 81% of their physician directory entries, according to a study published in JAMA Open Network.
Researchers from the University of Colorado School of Medicine and HiLabs searched physician information in the Medicare Provider Enrollment, Chain, and Ownership System database in online physician directories of UnitedHealth, Elevance, Cigna, Aetna, and Humana, based on physician name and zip code in September 2022.
The analysis considered a physician's information as consistent if it was the same among all locations or specialties across all directories in which the physician was found. Physician information was deemed inconsistent if the physician address or specialty was different across directories or if a physician was found in a directory without an address or specialty that was found in another directory.
Of the 634,914 unique physicians in the database, 449,282 were found in multiple directories, with just 19.4% of those having consistent address and specialty information across all directories they were found in.
Over a quarter (27.9%) of physicians had consistent practice location addresses, while over a third (67.8%) had consistent specialty information.
Among physicians who had only one practice location listed, consistency was 58.6% for address and specialty information, 84.8% for practice address, and 68.6% for specialty information.
"These results were driven by inconsistencies in addresses among physicians listed as practicing at multiple locations, which is concordant with prior research suggesting that most address errors stem from group practices reporting all physicians at all practice locations to insurers, irrespective of each individual physician's practice locations," researchers wrote.
The study highlights the unintended consequences of inaccurate physician directories, which includes but is not limited to surprise billing.
"Beyond surprise billing, inaccurate physician directories can lead to delays in care due to difficulty finding the correct physician, challenges in regulators assessing health insurer network adequacy, and misrepresentation of network depth and breadth as consumers select health plans," researchers stated.
The No Surprise Act requires health plans to maintain accurate provider directories, but the report notes how lack of standardization is making that a challenge.
When the administrative burden to inform and send updates to insurers falls on providers, the collective cost is $2.76 billion annually, according to a report by CAQH.
"This study's findings highlight the need for unified technology-enabled solutions, such as that proposed by the Centers for Medicare & Medicaid Services, which is seeking to create a single, centralized physician directory using modern interoperable formats," the authors concluded.
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
Analysis of health plan provider directory entries for over 40% of U.S. physicians found inaccuracies for 81% of physicians examined across UnitedHealth, Elevance, Cigna, Aetna, and Humana.
The findings were largely the result of inconsistencies in addresses among physicians listed as practicing at multiple locations.
Inaccurate provider directories can lead to surprise billing and delays in care, and can be difficult to combat due to lack of standardization.