Optimizing Provider Network Data to Boost Efficiency, Patient Experience and Compliance
Provider network information supports payers’ requirements for claims, network adequacy, directory accuracy.
As health plans strive to reconcile, manage and maintain quality data within their provider network, they need to address and improve data quality in order to leverage it efficiently and effectively.
Provider network information supports payers’ requirements for claims, network adequacy, directory accuracy.
As health plans strive to reconcile, manage and maintain quality data within their provider network, they need to address and improve data quality in order to leverage it efficiently and effectively.
To properly store, update and disseminate data, health plans and provider organizations need an approach that manages master data and serves as an internal, foundational data store. This should include data points within the provider network such as provider credentials, demographics, locations and contact information.
Health plans currently get snippets of provider data from claims, provider group rosters, and the contracting and credentialing processes. Often, the data captured from each of these does not align, has some degree of inaccuracy and may not be up-to-date. 
To address these data weaknesses, health plans should corroborate information across different data sources using data management solutions. This presents the critical need to adopt a multi-faceted approach that utilizes claims analytics, machine learning, and additional industry touch points to provide context and validation for those data sources.
Provider Data Management is at the heart of managing this vast amount of data. Most provider groups share their information with more than 10 health plans. Large payer groups can receive updates from a network of up to thousands of groups within their provider network. The challenge is ensuring this information is validated and accurate. It's time for the healthcare industry to have a single hub that leverages all of the cross-industry touchpoints with providers across the continuum of care to help identify anomalies in the data and drive greater accuracy.
Moving to a single hub would lower costs by eliminating duplication and overlaps, ensure distribution of updates, and reduce lag time. Physicians within the provider network would have a sense of accountability with and confidence in a single source rather than fragmented processes. Download our paper to learn more about tapping the full potential of available provider data to improve overall efficiencies and data accuracy.
