InterSystems HealthShare Provider Directory

Inaccurate provider information has serious consequences. For patients, it can mean delays in care. For members who unknowingly choose an out-of-network provider, it can result in catastrophic healthcare bills. Health plans may face hefty fines for inaccurate directories. And providers trying to market themselves through their digital front door risk alienating the very people they hope to attract. An analysis of directory entries for over 40% of U.S. physicians found inconsistencies in 81% of listings across five major national health insurers¹ - highlighting the prevalence of ghost networks and the ongoing challenges of maintaining accurate provider data.

InterSystems Provider Directory is a provider data management solution that collects, consolidates, and publishes information about healthcare providers and their relationships to patients, health plans, and one another. Provider Directory helps to comply with laws like the No Surprises Act, and regulations like CMS 9115-F and CMS-0057-F, enhances the consumer experience, and improves the efficiency of any business process that depends on accurate, up-to-date provider data.

InterSystems Provider Directory can also function as part of your organization’s broader master data management strategy, compiling provider, organization, and network data from multiple, disparate sources—each with its own formats and structures—into a complete and accurate Golden Record.

Provider Directory uses a robust linkage engine and business rules to match provider records, provider organizations, and extensions of your network—including community-based organizations, vendors, and other service providers.

During processing, Provider Directory normalizes the data, deduplicates records, applies validation rules to detect errors, and uses configurable logic to consolidate matched data into a single master record for each entity.

Provider Directory includes an extensible data model that allows for searching and viewing individual providers, organizations, contract administrators, networks, plans, addresses, and the relationships between them for a complete picture of your enterprise.

The Data Steward portal is the central access point for managing all records in Provider Directory. Authorized users can search for and view records, compare data across all contributing records for a single enterprise ID, and review change history. The users may also manually edit or enter information into the directory for all record types.

Provider Directory delivers unsurpassed transparency into the process of creating and updating master records out of the box. These features allow authorized users to:

• Filter information by date, time, and source
• Establish data hierarchies based on the most trusted data sources
• Implement survivorship rules to ensure only fresh data is visible in the golden record
• Track when record updates have occurred and the source of those updates
• View details about update sources
• Examine source records that contributed to a master record and the rules that governed their use
• Remove unwanted updates from the directory in bulk or one at time.

Provider Directory includes FHIR APIs that allow data sharing via the DaVinci Plan Net implementation guide required for compliance with CMS-9115-F.

Supported FHIR Resources:

• Endpoint
• HealthcareService
• InsurancePlan
• Location
• Network
• Organization
• OrganizationAffiliation
• Practitioner
• PractitionerRole

InterSystems Provider Directory also publishes public REST APIs for searching and retrieving individual provider and provider organization records. Information supplied includes related organizations, locations, and networks.

InterSystems Provider Directory can be deployed on premises or as a fully managed service.

When you subscribe to InterSystems Provider Directory Managed Services, InterSystems designs, hosts, and delivers the integration platform so you do not need to purchase, operate, secure, or maintain the infrastructure yourself.

InterSystems Managed Services include:

• All data center resources, including hosting, hardware, and network capacity needed to run the solution
• Ongoing maintenance of all solution components
• Customer-specific configuration and implementation services to bring the solution live, including building connections
• 24/7 support for the solution including real-time monitoring
• Seamless upgrades
• Sophisticated security and data protection programs

InterSystems EMPI is backed by InterSystems acclaimed customer support and educational services. For more information visit Support.InterSystems.com or Learning.InterSystems.com.

1 - Consistency of Physician Data Across Health Insurer Directories, JAMA, March 2023.