In Medical Economics: The Hidden Provider Data Problem Landing on Physician Practices

New research shows provider data errors are a monthly reality for nearly every health system and health plan. Madaket CEO Megan Schmidt explains why AI won’t fix it on its own.

Every claim, every referral and every enrollment starts with a provider record. When that record is wrong, someone pays for it. According to a recent Medical Economics report, that someone is usually the physician practice.

The article, “The hidden data problem costing physicians time, referrals and patients,” by Todd Shryock, draws on new research commissioned by Verato and fielded by Sage Growth Partners among 151 health system and health plan leaders. The findings show a wide gap between how much leaders value provider data and how well they can use it:

• 92% of health systems and 98% of health plans run into provider data inaccuracies at least monthly.
• Only 12% rate their data quality as excellent.
• 82% of health systems name revenue cycle and claims denials as a top use case for provider data, but only 41% say they use their data well for it.

Megan Schmidt, who is quoted in the piece, explains why the problem is becoming more visible, not less. AI tools are exposing payer data problems rather than solving them, she says, because “they cannot establish a trusted provider record where one does not exist.” And when plans hold outdated or conflicting data, “the consequences often fall directly on medical practices” through delayed claims, denials and slower onboarding.

Why it matters for organizations that enroll providers for others

For RCMs, MSOs and billing services, that cost multiplies. One inaccurate record becomes a stalled enrollment, a denied claim and another round of rework, repeated across every client and every payer.

The research recommends an order of operations: establish one accurate provider record, keep it current, then build everything else on top of it. That’s the principle behind Madaket: fix the data first, then act on it.

Read the full article in Medical Economics →

Want to compare notes on how your team handles provider data today? Talk to our team.