Gartner Research

Medicare Advantage Regulations Force Provider Network Management Technology Upgrades

Published: 14 June 2018

ID: G00351250

Analyst(s): Bryan Cole

Summary

Medicare Advantage provider directory accuracy rules continue to tighten, and purchasers in other segments will follow. Current provider network management applications won't allow payers to comply. CIOs must invest in new technology, provider data exchange standards and business processes.

Table Of Contents

Analysis

  • Inaccurate Provider Data Bedevils Payers
  • CMS Medicare Advantage Oversight Forces Payer CIOs to Change Provider Data Models and IT Applications
  • Work With Business Leaders to Continuously Improve Provider Data Accuracy Through Underlying Operational Processes
  • Implement a Provider Engagement Hub to Coordinate Interactions
  • Expand Provider Demographic Data Exchange Standards

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