A large health plan with 2 million members had outdated provider directory information, with over 30% being inaccurate. This led to member and provider dissatisfaction and regulatory issues. The health plan contracted with Atlas Prime to validate provider demographic data for all 150,000 provider locations. Atlas Prime made calls, sent faxes and emails, and offered self-service options to validate the data. Their process included recording all calls and archiving materials for auditing. This improved the data accuracy in the health plan's directories, increasing member and provider satisfaction while reducing complaints.

1. 2 MILLION+ HEALTH PLAN
Case study for Atlas Prime

2. OVERVIEW
• The client is a large health plan on the east coast
• 2 million Medicare, Medicaid and Commercial members
• 150k provider locations
• Had outdated/stale provider demographic data
• Published provider directory information was over 30% inaccurate
• Considerable member and provider abrasion created regulatory
actions.

3. CHALLENGES
• Provider demographic data validation not a core competency
• Urgency to correct and produce accurate print and on-line provider
directories
• Directories with greater than 95% accuracy rate
• Internal IT resource constraints
• Requirement for audio recordings/scanned images of all provider
outreach encounters for third party audit/Quality Assurance
• Need to update provider data on a regular basis

4. SOLUTION
• Health plan contracted with Atlas Prime to validate provider
demographic data for each provider location in its networks.
• Atlas Prime validated provider locations via call center, fax,
email and self-service options.
• Atlas provided a solution that all telephone encounters were
recorded and printed materials were scanned and archived
for audit and quality assurance purposes.
• Calls were conducted by highly trained, US based call center
representatives.
• Atlas internal quality assurance program drove high rate of
data accuracy.

5. RESULTS
• Health plan saw immediate improvements in provider
demographic data accuracy in printed and on-line directories.
• Translated to increase in member and provider
satisfaction levels.
• Reduction in contacts with health plan customer service
representatives.
• Additional positive impacts were achieved in regulatory
surveys and compliance overall.