Tag Archives: data cleansing

Now is the time for health plans to start to think beyond compliance: How can you use this newly available data to support and improve critical business functions?

As the Payer market continues to evolve and the complexities continue to grow, so does the demand for higher quality data around providers at locations and accurate credentials. Despite these market dynamics, most of the state and federal source data that payers require to stay compliant with legislation remains stagnant, with quality levels that cause more challenges for the industry.

The No Surprises Act is going into effect in January 2022. While we wait for the regulation details to materialize, it is important to understand your baseline today to get ahead of what’s to come.

Josh Schoeller, CEO of LexisNexis Risk Solutions Health Care, recently shared industry insights in a candid interview with HIStalk, a healthcare technology industry blog.

With political changes also come regulation changes. Though surprise medical billing has long been an issue, Congress recently passed HR 3630 containing the “No Surprises Act”, to remedy the problem. This latest bill applies to all group and individual health plans, with an effective date of January 2022. Among other things, this regulation requires that provider directories be updated on a regular basis, every 90 days.