SPECIAL BULLETIN: Review of Current Issues with Searching the Enrollment Broker Provider Directory

As of the end of August 2019, several issues have been identified with the search function in the Enrollment Broker Provider Directory, including duplicate results, and difficulty finding doctors based on specific criteria such as gender or name. DHHS is working diligently to resolve the issues.

Currently, search results are inconsistent and have led to many questions. For example:

• Many individual doctors are searchable, but not all – dependent on various factors;
• Individual doctors are not searchable at their affiliated office locations; 
• Individual doctor results do not indicate to which group/practice they are affiliated;
• Many group/practice/organizations are searchable, but many are not, due to name search issues;
• There is not an easy way to filter on just Primary Care Providers (PCPs);
• Providers may have multiple names and not all a provider’s names are shown – i.e.: Organization/Doing Business As (DBA)/Service Location Name;
• Closed locations are showing in the results;
• End dated specialties (taxonomy) are showing for providers;
• Office hours are displayed in military time;
• Duplicate results are displayed for providers, due to criteria used to make the determination;
• Users are forced to search by location first; and
• Searches across providers who work in multiple counties is not supported.

Some of the issues encountered are due to a lack of network maturity. The Health Plans are in the process of building provider networks across regions. Others are the result of the functions built into the Provider Directory.  Because they range in cause and complexity, the timeline to address issues will vary. This document outlines:

• Current issues, root cause and planned resolution
• Questions providers have asked DHHS and responses

As a reminder:

• Beneficiaries must choose an Advanced Medical Home (AMH) / PCP or one will be assigned to them during auto-assignment. When choosing a PCP, beneficiaries will select a group or practice, not an individual doctor within that group or practice. 
• Sole practitioners designated as an AMH are an exception. These providers are also listed as a PCP option.

ROOT CAUSE AND RESOLUTION

Issue: Searching for groups/practices does not work consistently

Root Cause: There are three data fields where the group/practice name might exist; each with potentially different names; and only one might be searched for. Currently, the Enrollment Broker is searching on and displaying the organization name; so in some cases this may be the name of the practice being searched for, while in others it is not the way that group/practice is enrolled and named within NCTracks.

Resolution: The Enrollment Broker is working to change the search order on the group/practice name fields to search based on service location first, then DBA name second, and lastly on organization name. In effect, this reverses the current name field search order. We believe this will provide the best opportunity for the searches to return the expected results and is based on the way groups/practices have enrolled in NCTracks across multiple locations.

Issue: Searching for individual providers who work for a group/practice does not work consistently.

Root Cause: There are multiple causes for this result, based on the way the data is being sourced from the Health Plans to the Enrollment Broker, some of which include:

• Some plans don’t include the affiliated individual doctors as separate searchable records, while others do; so those providers not included separately will not show as contracted for that Health Plan. However, their names will generally be included in the detail of those groups/practices. This accounts for contracting variability seen between Health Plans.
• Searching on a specialty may fail due to a non-match with the enrolled provider’s specialty value(s) in NCTracks. Some practices enroll as “multi-specialty”, so searches on a specific specialty will not provide results.
• Searching for a provider at a known address may fail if the provider is only “affiliated” to that group/practice address in NCTracks. Providers “affiliated” locations are not currently included in the Enrollment Broker directory. This will be addressed long term.
• Duplicate results are caused by minor (non-displayed) differences in the provider data across plans. For example, one plan sends a provider’s middle initial, while another sends the middle name. Our short-term resolution will address duplication results.

Short-Term Resolution: The Enrollment Broker is working to filter out the display of individual providers who work for group/practices. This short-term solution enables the same search capability available through NC FAST, i.e.: limited to provider group/practice-based searches. NC FAST does not support the search for individual providers. To assist beneficiaries in finding the group/practice of their individual doctor(s), the Enrollment Broker call center staff will be provided with a resource to help beneficiaries locate the group/practice that an individual doctor is affiliated with in order to assist them in making a PCP selection.

Long-Term Resolution: The long-term solution will support a fully searchable provider directory. Users will be able to search by individual doctors across all affiliated addresses, as well as all the practices/groups across all provider types and locations.

We are currently estimating December to implement the full function provider directory. In the meantime, the current directory will provide an equal level of search capability as beneficiaries have today in NC FAST.

QUESTIONS AND ANSWERS

If beneficiaries can’t find me, how can they select the PHPs I am contracted with to select my practice?

• If a beneficiary doesn’t know the group/practice name of their PCP, they should contact the Enrollment Broker call center.
• The Enrollment Broker has additional resources to lookup individual doctors and determine which group/practice they are affiliated with. Once the group/practice name is determined, the beneficiary can search the provider directory to view the list of contracted PHPs. 

If the provider name on the Enrollment Broker website doesn’t match how beneficiaries search for me, how will my practice be found through the auto-assignment algorithm, so they are assigned to PHPs that my practice is contracted with as their PCP?

• PHP Auto-Assignment – will automatically assign the beneficiary to a Health Plan. The Health Plan assignment uses several factors to auto-assign the PHP, including a beneficiary’s current PCP and the Health Plans with which the PCP is contracted.
• PCP Auto-Assignment – occurs at the selected Health Plan and will use historical provider information about the beneficiaries and attempt to automatically assign the beneficiary to their historical PCP. Auto-assignment uses the member’s currently assigned PCP, which is stored in NC FAST using additional data fields which are distinct from the “provider name” field used in the Enrollment Broker provider directory. In short, Auto-Assignment does not use the provider name for matching purposes.
• Open enrollment – provides beneficiaries a chance to select a Health Plan. Typically, the choice of Health Plan is based on the list of family doctors and those Health Plans with which they have contracted. Selection of a Health Plan by the beneficiary is completely optional and can be changed during the designated time period. It’s the Enrollment Broker’s main role to assist in this process.