Statewide Provider Directory
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Maintaining up-to-date information about provider participation in health plan networks is a challenge not just in California but across the nation. Consumers increasingly rely on provider directories to review networks when choosing a health plan, yet health plans have been challenged to provide accurate public provider directories that reflect the various types of providers available through their networks, their qualifications and capabilities, and their availability.
The first of its kind in the state, the provider directory utility will offer a single place for healthcare providers and commercial, Medicare, and Medi-Cal health plans to update their data; simplifying the process and leading to more accurate provider data, improved quality, and a better customer experience for Californians.
The project is an offshoot of the California Department of Managed Health Care’s (DMHC) approval of Blue Shield’s 2015 acquisition of Care1st Health Plan. As part of the agreement, Blue Shield committed to strengthening the health care delivery system in California, including development of a statewide centralized provider directory database.
Recognizing stakeholder engagement would be critical to the success of such an effort, Blue Shield in collaboration with DMHC convened an advisory committee representing health plans, providers, consumer groups, and regulators. The advisory committee defined the priorities, functions, and governance requirements of the provider directory tool and evaluated organizations as potential hosts for this utility, selecting the Integrated Healthcare Association to develop and manage this cutting-edge resource.
IHA will develop a provider directory which will offer participating organizations with on-demand, accurate, and affordable provider data to support both consumer purchasing decisions and other potential use cases.