Health Payer Intelligence July 22, 2022
At least half of Oregon Medicaid providers were a part of the “phantom network”—providers that are listed on the Medicaid provider directory but never saw Medicaid enrollees.
The Oregon Medicaid program’s provider directories may have included hundreds or thousands of providers who never saw Medicaid enrollees, according to a Health Affairs article.
“Understanding the extent to which beneficiaries can ‘realize’ access to reported provider networks is imperative in mental health care, where there are significant unmet needs,” the researchers explained.
“Significant discrepancies between the providers listed in directories and those whom enrollees can access suggest that provider network monitoring and enforcement may fall short if based on directory information.”
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