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Provider Data Quality

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The Importance of Accurate Provider Data

It's not enough for healthcare organizations to simply store provider data; it must be accurate and complete. Sound practices around provider data quality is part of operational management. Part of this management includes provider directories that are an invaluable resource to your network.

Inaccurate provider data can lead to poor patient access, government sanctions, reduction in profits, and inefficient business operations. This can also lead to gaps in care due to untimely communications between patient and physician.

Accurate and complete provider data can offer organizations the opportunity for increased revenue growth, improved workflows and better patient outcomes.

An analysis of the healthcare industry has revealed:

Lack of Communication

An estimated 40 percent of healthcare provider records have missing or outdated information that results in inefficient patient and physician communication.

Unreliable Contact Info

Around 2.4 percent of provider demographics change on at least a monthly basis.

Changing Relationships

Approximately one-third of doctors change affiliations each year. As a result, businesses holding poor data increase their recruitment costs with wasted human resource time, poor targeting, and lack of background information, to name a few.

Instability

Bad data can have a devastating impact on a business' turnovers and can result in anywhere between 10 and 30 percent of lost revenue.

How Cleansing and Augmenting Provider Data Helps Healthcare Organizations

Cleansing and proactively maintaining accurate provider information can introduce a range of operational efficiencies which have the potential to translate into substantial revenue each year.

Updated and accurate data improves compliance with CMS and other regulations pertaining to provider data quality. Augmented and cleansed provider data lowers the compliance risks of inaccurate data and wasteful campaigns, field calls and other targeting that can negatively impact your revenue.

Lastly, accurate provider data improves communication, creates operational efficiencies and enhances care coordination to improve the patient experience and overall care.

How LexisNexis Ensures Provider Data Quality and Accuracy

LexisNexis data solutions can be integrated into existing workflows to enhance provider data quality while improving operational efficiency, coordinated care, and patient satisfaction while maximizing cost savings.

We offer two solutions to help your healthcare business enhance its provider data quality.

LexisNexis Provider Data MasterFile™ provides healthcare organizations with complete, current, and comprehensive provider data that can transform their network management. It is the gold standard for provider information and benefits from our data governance standards so you can make decisions with confidence.

Accurate provider data allows healthcare businesses to have a complete view of more than 8.5 million U.S. healthcare practitioners and 1 million organizations. Provider Data MasterFile™ can also fulfill regulatory requirements like those from the Centers for Medicare and Medicaid Services (CMS).

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LexisNexis ProviderPoint^® equips businesses with real-time notifications of critical issues with providers or contracts, allowing for immediate action and improved compliance. The healthcare organization’s provider file is augmented with additional data attributes based on the business rules and requirements.

After those rules are applied, ProviderPoint delivers a 'golden record' of information, along with integration codes and recommended action steps. This solution allows for customized file formatting that allows users to automate information updates.

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Medical practices and office managers need a solution that allows them to easily attest and engage in provider data management. Our ^®VerifyHCP portal supplements this effort by allowing staff to attest physician data and physicians to verify plan participation.

Using machine learning, the industry’s leading source of provider data and more than a decade of data management experience, this provider directory solution goes beyond regulatory requirements as they relate to maintaining the accuracy of published directories. It also identifies inactive providers and locations resulting in immediate improvements to provider directory accuracy.