Stay Compliant with VerifiCarePro
Maintaining compliance with CMS, Medicare Advantage, Medicaid, and state directory regulations requires:
Compliance Protection
Automated compliance monitoring and real-time provider data validation to prevent costly penalties.
Advantages for Payers and Providers in Keeping an Updated Provider Directory
Based on industry data and operational analysis
For Payers
(Health Plans)
Regulatory Compliance Cost Avoidance
CMS fines can reach $25,000 per Medicare beneficiary per day for inaccuracies. Maintaining an accurate directory avoids these potential penalties.
Reduced Call Center Costs
Up to 30-50% of member calls relate to provider directory inaccuracies (CMS, AHIP data). Accurate directories can reduce call volume, saving millions annually in large plans.
Improved Member Retention & Satisfaction
50% of members report frustration or switching plans due to inaccurate directories. Keeping data updated enhances CAHPS scores and Star Ratings, leading to higher CMS bonus payments.
Operational Efficiency
Decreases manual outreach and rework time by 40-60%, freeing staff for higher-value tasks.
For Providers
(Hospitals, Clinics, Practices)
Increased Patient Acquisition
Accurate listings can boost new patient appointments by up to 35%, as patients find correct location, specialty, and availability.
Reduced Claim Denials
Inaccurate provider information causes claim mismatches. Updated directories reduce claim rejections by up to 25%, improving cash flow.
Enhanced Reputation & Patient Trust
80% of patients check online or directory information before appointments. Accurate listings enhance patient trust and brand image.
Streamlined Referral Management
Updated directory entries improve referral accuracy by 20-30%, reducing leakage and retaining revenue within the network.
How VerifiCarePro Helps You Stay Compliant
Ensuring compliance is crucial. VerifiCarePro simplifies the process with advanced features designed to keep you audit-ready and minimize risk.
Automated Outreach and Verification
Ensures all provider information is confirmed at required intervals with minimal manual follow-ups.
Attestation Tracking
Maintains comprehensive records of provider confirmations for audit readiness.
Real-Time Updates
Instantly reflects changes across systems to meet regulatory timelines.
Integrated Compliance Reporting
Generates ready-to-submit reports for regulatory audits and internal governance.
Scope of Work
Gathering accurate provider credentials and documentation.
Cross-checking submitted information against trusted databases.
Engaging with providers for missing or outdated information.
Delivering actionable compliance reports
Frequently Asked Questions
Get answers to common questions about VerifiCarePro implementation, features, and support.
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