Confidence But With Caveats

Most leaders trust their provider eligibility data. But the key is understanding why— and why it also falls short.

At first glance, confidence looks strong. Nearly two-thirds of healthcare executives (64%) say they are extremely or very confident in the quality of their organization's provider eligibility data. That's an encouraging headline.

But a closer look reveals the picture is more complicated. Only 23% are extremely confident. The largest group, 41%, lands on 'very confident.' That's not a crisis, but it's not a clean bill of health either.

A meaningful 27% are only somewhat confident. Another 9% are not too confident. No organization rated itself completely unconfident, but the cumulative weight of 'somewhat confident' and 'not too confident' adds up to 36% or more than one-third of the field.

Among executives who express high confidence, the reasons they offer help clarify their perspectives. They cite continuous monitoring of data quality, governance, and validation processes, and automated eligibility verification systems, which are genuinely good practices. They are also not universally in place.

This data reveals that some executives are confident because their systems “work” for them. Others may be confident because they haven't yet seen where their systems break down.

“We continuously monitor, reconcile, and update our provider data, which gives us assurance in its completeness and accuracy.”

—Survey respondent

Among executives who express lower confidence, the reasons are concrete. They describe inconsistencies across systems, manual processes that introduce errors, and third-party data that isn't always up to date.

One respondent put it this way: “Data from external sources isn't always updated in real time, and departments sometimes follow different workflows or validation steps.”

“Gaps in accountability, along with manual handling of data, make it harder to maintain accuracy.”

—Survey respondent

The same confidence gap shows up in data governance. Only 18% of executives say they are extremely confident their organization's governance approach is the best it can be. Nearly one-third (30%) are only somewhat confident. The top data governance challenge, cited by 57% of respondents, was keeping up with changing regulations.

Regulations don't slow down and wait. Neither does provider data. Organizations that rely on periodic reviews and manual checks are already running behind.