Availity Blog

Provider Complaints about Payer Requests for Risk and Quality Information


8.29.2016 by AVAILITY

Availity Access provides a glimpse into the people behind our products. It features commentary and insight on the challenges facing the healthcare industry and how Availity can help providers and health plans better share healthcare information. This episode discusses the concerns providers have about frequent requests for risk and quality information from payers.

Payers need information about the population of members in their health plans to predict and track healthcare costs and to comply with regulatory requirements for risk adjustment and quality assessment. The latter is particularly important for members in Medicare Advantage, Medicaid managed care and Affordable Care Act (ACA) plans. Most providers understand this, but as health plan information needs expand, so does the volume of requests they receive for assessments, attestations, and medical record documentation.

To better understand how these requests affect providers, Availity hosted discussions with providers in our nationwide network. Susan Bellile, Availity’s Principal of Health Plan Risk & Quality, talks about their top complaints and offers suggestions on how to improve the status quo. You might be surprised by some of the provider responses.

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