CMS Suggests Use of NPPES for Verifying MA Directory Entries

Though a small assist in the gargantuan task that is improving Medicare Advantage provider directory accuracy, CMS’s new plan to use the National Plan and Provider Enumeration System (NPPES) as a reference source may help insurers gain better insight into the accuracy of their own data. But insurers should be wary of the database’s shortcomings, and they will have to work with their provider partners to ensure that they are making timely updates to the NPPES, industry experts advise.

As of Jan. 1, the NPPES will enable providers to substantiate the accuracy of their National Provider Identifier (NPI) data, according to a Jan. 3 memo from the Medicare Drug & Health Plan Contract Administration Group within the CMS Center for Medicare. The NPPES contains certain core directory elements (e.g., name, address, specialty, telephone number) in “a machine-readable format for virtually every provider in the country,” explained CMS. The agency has for years maintained that accurate directory data is critical for beneficiary access, while repeated reviews of online directories have found that they are rife with errors.

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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