A Comprehensive Provider Data Management Solution
Provider Data Management is the Foundation for Better Consumer Experience and Managing the Complexities of Provider Relationships
Inaccurate provider information has consequences – for patients, payers, and providers. Wrong telephone numbers and location information limits access to care. Inadvertently choosing an out-of-network provider can result in catastrophic healthcare bills. Health plans have been fined hundreds of thousands of dollars for publishing inaccurate directories. And inaccurate information propagated across multiple clinical and administrative systems at a hospital or Integrated Delivery Network can negatively impact efficiency and cash flow. A 2017-2018 CMS review of Medicare Advantage Organization provider directories found that nearly 49% of them contained inaccurate information.
InterSystems HealthShare Provider Directory is a provider data management solution that automates the process of collecting, consolidating, and publishing accurate provider information. It makes it easier to comply with regulations such as CMS 9115-F for patient data sharing and certain provisions of the No Surprise Act, optimize the consumer experience, and improve the efficiency of any business process that requires up-to-date and accurate provider information.
As part of your journey to a consumer digital engagement strategy, having accurate data at one of a patient’s or member’s first touchpoints is essential.
Mastering a Single Source of Truth for Provider Information
HealthShare Provider Directory compiles data from multiple disparate sources each with their own data formats and structure that need to be harmonized, including NPPES national provider identification files. It uses a linkage engine and business rules to select the most accurate and up-to-date information, and creates master records for individual providers and provider organizations. The master record is the single source of truth storing common attributes for these entities and supports the many relationship structures that occur in healthcare.
The platform includes the organizational, location, and network relationships needed to navigate care delivery. Additional attributes include contact information, demographics, credentials, identifiers, specialty, education, and direct email addresses. It manages the complex relationships that exist in any provider network.
Provider Directory ingests and processes data from multiple sources. Its linkage engine identifies matches for individual provider records, provider organizations, and extensions to your provider network, including community-based organizations, vendors, and other service providers. During processing, Provider Directory normalizes the data, de-duplicates it, applies validation rules to screen for errors, and uses configurable business rules to consolidate matched data into a single master record for each entity. When matching-results on the incoming records fall below a user-determined level of confidence, Provider Directory flags the records in a task list for human intervention.
The Task List contains linkage tasks for individual providers and provider organizations that require manual review or validation. Each task on the list displays the data source, source record name, and source IDs of linked records. The Task List is sortable by work category, link reason, link weight, and task date, all of which are displayed in the user interface. Task List provides all the information needed to make informed decisions about linkages for individual providers and provider organizations.
Provider Directory includes phonetic, location, and organization type search functions. These features make it easier and faster to find provider information.
Intuitive User Experience
The Master Browser is the central access point for managing all records in Provider Directory. Its authorized users can search for records, see overviews, and review the content of all record types, including individuals, organizations, locations, addresses, networks, health plans, and contract administrators. Authorized users may also manually edit or enter information into the directory for for these entities.
With so many healthcare business processes depending on accurate provider data, trust of the data in your provider directory is essential. HealthShare Provider Directory inspires such trust through features that deliver unsurpassed transparency into the process of creating and updating master records. These features allow authorized users to:
- Filter information by date, time, and source
- See and adjust the rules used to determine the most accurate sources of information
- 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 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.
Supported FHIR Resources:
HealthShare Provider Directory publishes public REST APIs for searching and retrieving individual provider and provider organization records. Information supplied includes related organizations, locations, and networks.
Flexible Deployment Options
Provider Directory is one of InterSystems HealthShare cloud solutions.When you subscribe to Provider Directory Cloud, InterSystems designs, hosts, and delivers the integration platform so you do not need to purchase, operate, secure, and maintain the infrastructure yourself. Provider Directory Cloud 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
Provider Directory is also available on premises/private cloud.
Customer Support and Education
Learn more about Provider Directory and all the products within the suite of HealthShare connected health solutions.