Frequently Asked Questions

What is the Statewide Provider Directory Utility (PDU)?

The PDU is a centralized, statewide cloud-based technology platform for providers and health plans that will serve as a single source for provider directory data such as demographics, services, products and networks.  The PDU will help maintain up-to-date, accurate, on-demand data about provider participation within health plan networks in California.  The PDU will lower the administrative burden for plans and providers, making it easier to meet regulatory and business requirements, and ultimately for consumers to find the right providers and select the right health plan.

What problem is the PDU solving?

Maintaining up-to-date information about provider participation in health plan networks has been a long-standing challenge.  The Affordable Care Act magnified this issue as more consumers made health care coverage decisions based on inaccurate provider data.  Today, health plans and providers spend millions of dollars and countless hours maintaining their provider directories that consumers use to find providers and choose health plans.  And the information is often still not accurate.  The PDU will support both health plan and provider needs by delivering accurate information, validating, verifying, and reconciling data, lowering provider directory management costs, and supporting compliance with SB 137*, Medicare and Medi-Cal requirements.

*SB137 refers to Senate Bill No. 137 and regulates health plans to take appropriate steps to ensure their provider directory information is up to date and accurate.

How will health plans and providers use the PDU?

The PDU will be a technology platform from which all health plans can pull verified and validated provider data to populate their online directories. Providers will use the PDU to update their demographic and panel data with all of their contracted plans through a single portal. Providers will not need to send data in different formats to each plan and they will not need to answer multiple requests from different plans to update their data.

Is the PDU a consumer-facing tool?

No, at this point the PDU is not consumer-facing as our top priority is to improve the accuracy of each health plan’s directory.  The PDU is the back-end database that will consolidate and reconcile provider data and send it back to plans and other multi-plan directories to populate their consumer-facing provider directories.

How will the PDU help consumers?

Consumers rely on provider directories when making decisions about which plan to choose.  Inaccurate provider directories are one of the biggest pain points for consumers. The PDU will help to ensure that health plans are able to consistently deliver accurate information to consumers in an efficient and cost-effective manner.

How did this initiative start and who will pay for the PDU?

As part of the California Department of Managed Health Care’s (DMHC) approval of Blue Shield’s 2015 acquisition of Care1st Health Plan, Blue Shield committed to investing in programs that strengthen the health care delivery system in California, including the development of a statewide, centralized provider directory database. To that end, Blue Shield is providing initial investments for the design, development, initial implementation, and launch of the PDU. While these initial funds will help create the PDU, IHA will eventually transition the PDU into a financially self-sustaining business through end-user fees. We anticipate that the administrative efficiencies and savings gained from the PDU will result in an overall cost reduction of managing provider data for every user.

Why is Integrated Healthcare Association (IHA) leading this effort?

Recognizing that stakeholder engagement is critical to the success of this initiative, in late 2016, DMHC and Blue Shield collaborated to guide a multi-stakeholder process to create the PDU.   An advisory committee of health plans, providers, consumer groups and regulators and key work groups was formed (click here to review detailed technical requirements and other deliverables from the work groups).  The advisory committee defined the priorities, functions and governance requirements for the PDU and evaluated organizations as potential hosts for this vital resource.  The committee recommended that IHA lead this initiative because of our experience as a neutral and trusted convener for people who shape healthcare in California, our history of success in solving complex, multi-stakeholder problems, as well as our experience helping our members harness the power of their healthcare data.

How were the scope, governance and requirements for the PDU initiative determined?

There have been many attempts to solve this problem, but no solution has achieved the critical mass of participants needed to make a centralized solution work.  In 2016, the multi-stakeholder work groups (referenced above) defined the use cases the PDU must support and further defined the data elements and business and technical requirements.  If you are interested in reviewing detailed information about the PDU requirements, etc., the deliverables from these work groups are publicly available here.

If a health plan is using the PDU, will this guarantee compliance? What are the roles and responsibilities for health plans, providers and the PDU in terms of meeting compliance?

No, the PDU will not handle the full scope of what is required for compliance, but it will make it easier to achieve compliance with SB 137, Medicare Advantage, and Medi-Cal requirements.  The PDU will take on significant parts of the provider data management process for plans and providers, but plans will continue to be responsible for achieving full compliance (i.e. plans are responsible for using the data from the PDU to populate their directories, etc).

Plans can remove the parts of the process that the PDU handles from their internal workflows, so there should be no duplication of work.  However, plans are responsible for the parts of the process that the PDU does not cover (i.e. populating their directories with data from the PDU, etc.). For a PDF outline of roles and responsibilities by statute & regulation, click on the applicable link: SB-137Medicare AdvantageMedi-Cal.

How will the PDU ensure that providers maintain their information?

The PDU will significantly improve providers’ efficiency as they will update all plan information in one place at one time.  We plan to launch education and outreach campaigns to help providers understand what they need to submit and by when so that their processes are ultimately streamlined and they do not get inundated with requests for their information.  Consistent education and outreach will be essential to help providers understand what is needed and how to use the PDU to save time and resources.

What will the PDU do if providers who need to update their data do not respond?

The PDU will make several attempts to contact non-responsive providers.  If a provider is non-responsive after exercising all of the PDU’s outreach processes, the PDU will provide an auditable trail of every interaction and flag these providers so that the plans can take the necessary steps required by SB-137 or other regulatory requirements.

Will the PDU validate health plan network information?

The PDU will validate and verify provider data, including which providers are in which networks.  If conflicting data exist, the PDU will notify plans and providers and work with both to resolve the conflicts.

Will the PDU also collect and reconcile data for credentialing, Health Information Exchanges or All Payer Claims Databases?

No, not during the initial phase of the PDU’s development.  Although we recognize that the core provider data set is consistent across multiple use cases such as credentialing, the initial launch will focus on the data for plan’s consumer-facing provider directories (i.e.  practice location, products accepted, and whether or not providers are accepting new patients). We anticipate that we will expand the capabilities of the PDU in the future, but to be successful, we are limiting the initial scope and focusing on accurate provider data first.

When will the PDU be available to all plans and providers in California?

We are beginning the soft launch of the PDU in Q2 of 2018. During this phase, our soft launch participants will use the system and provide input to help shape the capabilities of the PDU. Upon successful completion of the soft launch, we plan to publicly launch the PDU in early 2019.

Who is participating in the soft launch?

The three health plan participants are Anthem Blue Cross, Health Net, and Blue Shield of California.  IHA is also identifying a small number of diverse provider groups to include in the soft launch.

What is the role of the participants in the soft launch phase?

The health plans and providers will help IHA test the full functionality of the PDU.  This phase will exercise the PDU and its dependent processes to validate the system, test business and technical assumptions, identify risks, and add necessary enhancements to resolve newly discovered issues and create an engaging user experience.  Although we anticipate great efficiencies to come from the PDU, it is important to implement the PDU in a limited capacity where risks can be controlled and the technology is evaluated based on real life scenarios.

What provider types are in scope for the initial launch of the PDU?

For the initial launch in 2019, the provider types are limited to all the providers in a plan’s directory including physicians, facilities, and mid-level providers. Pharmacy networks, ancillary providers and non-MD providers such as dentists and chiropractors will be included in future releases.

How does an interested organization participate in the soft launch?

Please send a message to support@iha.org if you are interested in participating.  Although we don’t have an exact timeline for when additional organizations will be able to participate in the PDU, we aim to be as flexible as possible.

How did you select the PDU technology vendor?

After a 7-month process that included over 25 vendors, IHA, with input from a broad group of stakeholders, selected the partnership between Gaine and Availity as our technology vendor.  Our vendor selection process began in earnest in mid-September of 2017. We canvassed many vendors, leading to a list of 25 vendors with relevant experience in provider data management. We conducted a request of information (RFI) of the 25 vendors and narrowed our list to several candidates who then received invitations to submit responses to our request for proposal (RFP).  After a thorough vetting process and evaluation of proposals by many stakeholders across the industry, with oversight and final decision-making from IHA’s Executive Committee, Gaine and Availity were selected.

Why did you select Gaine Healthcare/Availity as the PDU technology vendor?

We selected Gaine Healthcare/Availity due to their ability to meet the business and technical requirements, their extensive experience in provider data management in California, and their ability to support IHA’s business plan.  The selection was made through a thorough canvass of the industry and market reviewed by internal and external committees; with oversight and final decision-making from IHA’s Executive Committee. We looked not only at the vendor’s technology, usability, price, and industry reputation, but also for strong customer support capabilities and meaningful market traction in California.

Why are both Gaine Healthcare and Availity supporting the PDU?

Vendors invited to submit an RFP were allowed to partner in order to meet all business and technical requirements. The two companies together offer complementary provider data management solutions and work to connect providers, provider organizations, and health plans. Together, they will make the PDU more effective for all stakeholders.

What are Gaine Healthcare/Availity’s responsibilities as the technology vendor?

Gaine Healthcare/Availity are responsible for developing and supporting the technology and product.  Gaine Healthcare/Availity will partner with IHA to build a product that will address the many different types of users in California, and will provide extensive customer and technical support to help users adopt this new technology and provider directory data management process.

Will the PDU replace all existing vendors in California?

Collaboration among vendors, health plans, health systems and providers is key to successfully solving this industry-wide problem. The PDU expects to work with vendors who are also addressing this need. The PDU will be a central “source of truth” for provider and provider-plan data.

Is the Gaine Healthcare/Availity technology best-in-class?

We have and will continue to make it a top priority to review all available technologies.  We will continue to look at applications for blockchain, AI, crowdsourcing, and others and ensure that the PDU uses the right technology to continue to solve this problem and improve data accuracy.  At the moment, it is not clear how blockchain and other emerging technologies should be used in the healthcare industry.  We will continue to discuss innovative and effective methods to manage provider, encounter and other types of data.

How can I find out more about the PDU?

To stay informed, sign up here to receive our updates. In addition, see our News & Events page to find out where IHA will present at conferences throughout the year.