Streamlined, high-quality directory data
Streamlining provider data exchange for improved accuracy and compliance
For health plans, reaching out to providers for information updates per state and federal requirements is time-consuming and difficult.
The Symphony Provider Directory simplifies how plans gather data from providers to easily maintain compliance with these requirements.
Instead of receiving multiple data files in different formats and calling providers for clarification, you can access standardized provider information through Symphony to efficiently update your directory and help patients access the right information.
Did you know
$2.1B
is spent per year by commercial health insurers to maintain provider databases
$25,000
is the fine per error per physician that plans face if they fail to keep their member directories up-to-date
49%
of online provider directories for Medicare Advantage Organizations had at least one inaccuracy. (2018 CMS Report)
Simplifying the data exchange process
The Symphony Provider Directory provides a single platform for routine attestation and delivery of provider directory information, enabling rapid alignment and reducing administrative fatigue. How this works:
1
Health plans submit data weekly, biweekly, or on another established cadence.
2
Providers submit and attest to their data and receive regular reminders.
3
Symphony validates information against participant-supplied data and third-party sources using data tuning policies to determine the most accurate “golden record.”
4
Symphony issues reports and notifications with recommended updates flagged.
Supporting state and federal compliance for plans
We work closely with regulators to ensure that our advanced platform supports evolving state and federal mandates, helping you stay compliant. Symphony meets state and federal regulatory requirements, including:
- Conforming to the uniform data standards and provider outreach requirements established by DMHC and the California Department of Insurance in SB 137.
- Supporting verification, validation, and updates about primary care providers and other physicians required by the California Department of Health Care Services (DHCS) for Medi-Cal Managed Care members.
- Supporting provider information based on CMS specifications and enabling quarterly provider notifications to validate and process updates. We generate files to aid updates and flag providers that are non-responsive.
- Capturing the required data elements and supporting quarterly outreach guidelines outlined in HR 133.
Addressing challenges in maintaining accurate provider data
Obtaining correct provider data and keeping it up-to-date is difficult. Disparate sources of information, multiple formats and locations for data storage, and difficulty validating the information with trusted sources are just some of the barriers. How Symphony helps:
- Advanced data tuning technology consolidates and validates data with numerous primary and secondary sources to achieve a “golden record” of the most accurate provider information.
- A single source of truth for provider directory information enables trust in the data and improves its accuracy over time.
- Providers receive automatic prompts to correct their information and plans get reports and notifications with recommended updates, enabling you to act quickly on provider data inconsistencies.