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Grow your Medicare Advantage Star Rating, Starting With Provider Data

CAHPS, access, complaints, appeals, and network adequacy all roll up into your Star Rating. Every one of them is depressed by the same root cause: inaccurate provider data. PRIME® fixes the root cause. 

Grow your Medicare Advantage Star Rating, Starting With Provider Data

Why CAHPS Score Matters for Health Plans

A half-star movement in a Medicare Advantage contract can be worth tens of millions in Quality Bonus Payments and rebate dollars. Yet the measures most sensitive to provider data, including CAHPS, Getting Needed Care, Getting Appointments Quickly, Complaints, and Rating of Health Plan, are the ones most quietly eroded by directory errors.

CMS has raised the weighting and scrutiny of patient-experience measures. Secret-shopper studies, No Surprises Act attestations, and directory accuracy audits have made provider data a direct Star Rating input, not a background operational metric.

What Atlas PRIME® Delivers

PRIME® treats the provider record as the upstream control point for STAR performance. Every capability below is tuned to the specific STAR measures that provider data most directly influences, so your quality team is improving rating inputs, not just cleaning up records.  

CAHPS Composite Protection:

Members can reach, book, and receive care from the providers your directory advertises, directly lifting the "Getting Needed Care" and "Getting Appointments Quickly" composites that carry the most STAR weight. 

Complaints and Appeals Prevention:

Data drift that generates member-service tickets, grievances, and appeals is caught before it reaches the member, protecting the complaint and appeals measures that feed into your annual rating. 

Wait-Time Compliance Verification:

Appointment availability and wait times are tested independently against CMS-required windows, giving your quality team verified, documented evidence of access performance before an audit requires it. 

Network Adequacy Coverage:

Geographic, specialty, and language coverage is validated against CMS standards, supporting the access and availability measures that roll directly into your rating calculation. 

Audit-Ready Attestation:

Every validation event is timestamped and source-cited, supporting No Surprises Act and CMS attestation workflows with documentation that holds up under regulatory review. 

How PRIME® Helps Improve Your STAR Ratings

STAR-Measure Mapping

Each data defect is tagged to the specific STAR measure it puts at risk, so operations teams see rating impact alongside the data issue, not just a list of records to fix.

Primary Source Validation

Confirms provider reachability, panel status, and network participation directly at the source, driving the CAHPS composites most sensitive to directory accuracy. 

Secret-Shopper Audits

Tests appointment availability, accepting-new-patients status, and wait times against CMS standards with independent, documented verification.

Continuous Monitoring

Detects license lapses, sanction changes, and demographic drift before they generate complaints, appeals, or audit findings.

Directory Accuracy Attestation

Produces timestamped, source-cited evidence for No Surprises Act and CMS attestation workflows.

What Better Provider Data Means for Your Star Rating

Star Ratings do not move with generic data cleanup. Every PRIME® validation action maps to a specific measure, so quality teams can trace exactly how data improvements translate into rating performance and QBP protection.

  • Lift in CAHPS "Getting Needed Care" and "Getting Appointments Quickly" composites

  • Fewer member complaints and appeals tied to directory issues

  • Stronger performance on access, availability, and network adequacy measures

  • A defensible audit trail for CMS secret-shopper and accuracy reviews

  • Protection of QBP revenue at your current star level, with a clear path to the next half-star

Proof in the Numbers

95%

Data confirmation accuracy reduces rework

90%

Validation success on first pass 

One

Source of truth, many downstream systems