Yes, thank you JBS. We were not trying to hide anything and have zero affiliation with Enclarity, we just know they exist by seeing their website over the years and news stories. In the 2nd paragraph of our initial response I did mention a service we provide to verify provider information. As JBS mentions, we are upfront with the profile. The only reason to make a comment here was to solicit input and follow the thoughts of the provider community on this topic. There are other discussion boards re: Enclarity's faxes which we have also followed.
Enclarity is much bigger and is attempting to be a FICO (credit scoring) type of service for healthcare information.
As far as CAQH and its service, if it appeared as if I was denigrating them in the initial response, then that was incorrect. This user account is for HealthDetail, but I can tell you that I spent 5 years working at one of the Top 3 (in size) insurers in the country for 5 years. The credentialing and consumer facing provider information (online/print directories, customer servicing, provider assignment) were completely different departments. Even if the credentialing dept got updated information on a provider, it wasn't shared. This is not uncommon because the credentialing dept sees its job as more related to compliance, which is accurate, vs. customer service...which might be where the directories are. No, it might not make sense, but it's the reality and certainly helps with the inefficiencies in healthcare. A providers credentials come from credentialing, but not the demographic info, hours, etc.
Instead of CAQH lets look at NPIs. The agreement with CMS says that each provider is to update changes to his NPI record within 30 days of the change. We can tell you from reviewing this file each month that it's not at all close to being done. How many viewing this thread have changed their NPI info (phone, billing address, practice address, licensures, taxonomy codes) since receiving their NPI? Very few, we know. In theory, that should operate similar to CAQH. And there is no membership for CMS/NPI.
I have no reason to defend Enclarity, or us, for verifying provider information and I think, in this case, anger at this practice is misdirected. There are definitely areas that companies make money "off the backs" of providers, Rx is a great example. But having a process to try to cleanse or fix incorrect info, is completely different. An earlier poster said he was "tired of seeing incorrect information" online about his practice and sent the info back. That is the purpose of this service. If CAQH can pull off being a trusted source of provider information, great, but hasn't fully happened so far. If so, CMS would use their info instead of requiring NPI updates directly.
One more example is that 2 years ago CMS contacted us to help maintain the Medicare.gov website. They recognized lots of info was incorrect and needed help keeping it up to date. (They later shelved the project.) If CMS has trouble with this...
No, we (HealthDetail) don't contact people more frequently. Both companies try to start with public sources, but when you have a conflict you have to figure which is correct. As stated earlier, if there are better options (pay is one) then would be interested in seeing. But I'm not sure paying Bob Jones to confirm that Dr. Robert G Jones is at 123 Main St is practical. From an insurers prospective, if the info is incorrect then Dr Jones may not get as many new patients so he already has a vested interest in making sure the info is accurate.
Darrell (for HealthDetail)
