Veda Provider Data Review
What is Veda?
Veda is Meridian’s trusted partner for ensuring the accuracy of our provider directories. As expectations from CMS and state partners now require at least 90% directory accuracy, both Meridian and our Participating Providers (PARs) must work together to meet this standard. Veda's cleansing solution is based in data science, machine learning and and social media sources to continuously clean and enhance provider data. This process helps ensure that our directories reflect the most accurate and up-to-date information.
What should I know as a PAR provider for a Meridian network/product?
Every 60 days, Veda applies its proprietary algorithm to scrub provider data across our Medicare, Medicaid, and Ambetter networks. The results – called suppressions – are shared with Meridian, allowing us to identify and correct inaccurate records.
- The scrubbing is an important part of our business relationship. Meridian will review the provided suppressions every 60 days.
- If the information suppressed in the directory is identical to what's been provided on your provider roster, we will reach out for guidance and alignment of how to resolve them. We will scrub all suppressions before reaching out for your support to make sure it's not an internal Meridian error that we can resolve without causing you any admin burden.
- We will need your support again when/if we find the suppression is caused directly by what's been provided on your roster. You should also know that while that record is suppressed it will fall off auto assignment logic for PCP when Meridian receives new members in need of a PCP.
Why would my record be suppressed?
The suppression is to make sure we are marketing the correct information to our plan members and also supports our accuracy of reporting to our state and CMS regulators. We want to make sure we are representing your group correctly! Below are the reason categories that you may see if you have a suppressed record:
Veda Disposition (status code) | Description | Detail | Action Needed |
|---|---|---|---|
Validated | Veda believes the record should remain in our provider directories as Practitioner NPI and Address Combination are valid (i.e., Practitioner actively sees patients at this location) |
| None-Keep in Directory |
Edit | Veda believes the record should remain in our provider directories as Practitioner NPI and Address Combination are valid, but a critical edit to Phone or Address is needed | Address update required | Keep in Directory |
Remove | Veda believes the record should be removed from our provider directories as Practitioner does not take appointments at this location | Better listed location available | Remove from Directory |
New | Veda has a new address for a Practitioner that is not in our source system and needs to be researched by the health plan | Better Veda location available | Health Plan to Research and confirm with Provider |
What do I need to do if Meridian contacts me about a Veda Provider Directory Suppression?
If Meridian reaches out regarding a suppression, here’s what you need to do:
- Review the Suppression Details
Determine whether you agree with the reason for suppression. For example, if the issue is an incorrect phone number listed in your provider roster, confirm whether the information is accurate. - If You Agree with the Suppression
Submit an updated provider roster to Meridian with the correct information. Once we receive the corrected data, we’ll update our system and lift the suppression. - If You Disagree with the Suppression
If the information flagged is correct, let us know. We’ll submit an un-suppression request on your behalf to reinstate the record and ensure it is exempt from future suppression for the same reason.