ATLANTA and CHICAGO – ( June 7, 2017) – LexisNexis® Risk Solutions and the American Medical Association (AMA) have launched the Verify Health Care Portal, the clinician attestation component of VerifyHCP, a robust solution for monitoring physician information that simplifies a successful data strategy for managing a health plan network. The Verify Health Care Portal uses payer directory information and combines it with LexisNexis Health Care’s database of healthcare professionals and its linking technology to pre-populate the portal with updated information on health care professionals to enable simpler and efficient attestation. As a result, health plans are able to present patients with more accurate directories of available health care professionals.
VerifyHCP is the only solution to take a payer consortium approach that leverages the power of the LexisNexis HPCC Systems® computing platform and proprietary linking algorithms and the AMA’s reach and engagement with physicians and practices to centralize and streamline the process of managing network directory accuracy.
Consumers depend on physician directories to access care. Publishing inaccurate information via directories poses a risk that patients may visit a physician who is not in network, potentially incurring thousands of dollars in unnecessary costs. State and federal regulations require health insurance plans to present patients with up-to-date network directories of available health care professionals. Many states have regulations that require regular data verification from clinicians to ensure accurate network directories. At the federal level, Medicare Advantage Plans, Qualified Health Plans and certain dental plans require quarterly outreach to health care professionals. In many states, Medicaid must conduct regular outreach on a monthly, quarterly or annual basis, and federal rules require Medicaid managed care organizations to update directories monthly.
The Verify Health Care Portal component allows clinicians to focus their time on patient care vs. administrative tasks by seamlessly fitting into existing office workflows to enable physicians and their office managers to update practice details for multiple health plans with a single sign-on, reducing the burden of non-clinical tasks. At the same time, it streamlines compliance with network directory accuracy requirements for payers and helps ensure patients know which of their physicians participate in their current health plans.
The power of VerifyHCP lies in its ability to pre-fill, collect, monitor, cleanse and update data in real-time. It also incorporates a multi-channel outreach campaign using email, fax, call and direct mail per the applicable regulatory guidelines. Enhanced flexibility of the solution is another benefit: It supports federal and state legislation requirements; the attestation needs of provider organizational structures and associations; has the ability to attest at the provider network level; and allows for office manager and group attestation.
The Verify Health Care Portal is powered by the physician resources of the AMA and its wholly-owned subsidiary AMA Business Solutions, and LexisNexis Health Care’s analytic technology, VerifyHCP and the LexisNexis® Provider Data MasterFile™. Among the nation’s most comprehensive databases of provider information, Provider Data MasterFile draws on more than 2,000 sources to build a powerful view of a clinician and covers more than 8.5 million health care professionals. The application leverages LexisNexis Health Care’s proven mastery in managing large volumes of data from thousands of sources and health care expertise to understand how and where this information is needed by consumers and health plans.
In November 2016, LexisNexis Health Care and the AMA agreed to collaborate to offer the Verify Health Care Portal.
We recently sat down with Laurie McGraw, Senior Vice President of Health Solutions, AMA and Lee Rivas, CEO, Public Sector and Health Care, LexisNexis Risk Solutions & President, Elsevier Health to discuss the ramifications of the Verify Health Care Portal.
LexisNexis Health Care – Why are LexisNexis Health Care and the AMA working together on the Verify Health Care Portal?
McGraw: As the largest professional membership organization representing physicians, the AMA is striving to reduce administrative burden so physicians can spend more time doing what they love: helping patients. Physicians