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CMS Provider Directory Review Report

Maintain Compliance

CMS Provider Directory Review Report

Between November 2017 and July 2018, The Centers for Medicare and Medicaid Services (CMS)
completed a 3rd round of Medicare Advantage online provider directory reviews.

CMS found that

48.7%

of provider directory locations
listed had at least one inaccuracy.

These inaccuracies included:

The provider was not at the location listed.

The phone number was incorrect.

The provider was not accepting new
patients despite what the directory listed.

30-60%

Percentage of inaccurate locations reported
by at a majority of Medicare Advantage
Organizations included in the report.

41.8%

Percentage of all locations included in report
that had directory inaccuracies with the highest
likelihood of preventing access to care.

The Results Are In

CMS issued the following compliance actions based on the results of provider directory reviews:

18

Notices of
Non-Compliance

15

Warning Letters

7

Warning Letters with a
request for a Business Plan

Don’t Let this Happen to You

Let Glenridge Health proactively monitor and manage the accuracy of your Provider
Directory data. During Provider Contracting, we can customize data collection based
on your plan’s needs – ensuring that your data is comprehensive and accurate.

We’ve collected and verified data that includes:

Does a provider see patients at particular locations?
Does the provider accept MA at all locations?
Is the provider accepting new patients?
Is the provider’s specialty listed correctly?
Demographic information including address, telephone number, practice name, provider name etc.