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The Symphony Provider Directory simplifies the way your plan communicates with providers so you can easily maintain more accurate directories in compliance with state and federal requirements.

We partner with you and your team to streamline the work associated with provider outreach, roster updates, data reconciliation, validation and processing changes.

Instead of juggling multiple data files and calling providers, you can access all provider information in one place to more easily update your member directory, create efficiencies, and help move our industry toward data standardization.

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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 updates

49%

of online provider directories for Medicare Advantage Organizations had at least one inaccuracy. (2018 CMS Report)

Using Symphony to simplify your workflow

The Symphony Provider Directory reduces administrative costs and plan fatigue by simplifying the data management process. We facilitate a transparent process so that plans and providers can hold each other accountable at every step and achieve better results together.

Diagram of how Symphony works

Supporting state and federal compliance for plans

We worked closely with regulators to develop the Symphony Provider Directory to ensure the platform could support and make it easier for providers and health plans to meet state and federal compliance. The utility meets requirements for regulatory bodies like the California Department of Managed Health Care (DMHC), California Department of Healthcare Services (DHCS) and Centers for Medicare and Medicaid (CMS) including:

  1. Conforming to the uniform data standards and provider outreach requirements established by DMHC and CDI in Senate Bill 137.
  2. Supporting verification, validation and updates about primary care providers and other physicians required by DHCS for Medi-Cal Managed Care members.
  3. Supporting provider information based on CMS specifications and enabling quarterly provider notifications to validate and process updates. We generate files to aid updates and will flag providers that are non-responsive, where necessary, including electronically and via phone.

Read more about how Symphony supports health plans in achieving compliance for:

Addressing challenges to obtaining accurate provider data

Plans face many challenges in both obtaining correct provider data and keeping that information up-to-date including barriers like disparate sources for information, multiple formats and locations for data storage and lack of access to easily cross-check information with other validated sources. To help address these challenges, the Symphony Provider Directory:

  1. Leverages primary sources by going directly to the source of truth for each data field, such as a signed contract between a plan and a provider or a national database. This is more effective than calling providers to verify because the person you speak with may not know what is on the contract.
  2. Consolidates provider directory updates in one  place, which allows the Symphony Provider Directory to determine which data is correct based on how many plans have the same information. If nine out of ten plans have the same primary phone number, it can be assumed with high confidence that the phone number is correct, unless the tenth plan is using a primary source.
  3. Brings transparency to the primary sources and data policies, so we can enable plans and providers to identify and reconcile inconsistencies (or “bad data”), resulting in improved data quality over time.

Additional resources
Learn about the uniform data standards published by DMHC

Learn how Symphony can fit into your workflow.

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