Solve the Challenges of
Provider Data Management
It’s Time To Fix The Digital Front Door
How would you feel if you received a referral for radiology, checked online to make sure the provider is in-network for your insurance, and then received an unexpected bill for hundreds or thousands of dollars after your visit? Or if you find a provider in a directory, but can’t get an appointment because information in the directory is wrong?
It doesn’t feel good.
If you’re not providing positive digital experiences for your patients or members, you could be losing them to competitors who are.
The Cost of Inaccurate Provider Information
To fix the digital front door, one thing you need is accurate provider information. But it’s not easy. You need to navigate multiple data sources and a complex and frequently changing web of physical and virtual addresses, office hours, health network affiliations, insurance accepted, billing address, education, specialties, licensing, and credentialing information. And some information varies by practice location.
Besides patient and provider frustration, inaccurate directories can lead to:
- Up to a $25,000 penalty per beneficiary assessed by CMS for errors in Medicare Advantage plan directories
- A penalty to providers of up to $10,000 for each violation of the No Surprises Act
- Referral leakage estimated at upwards of $97 million for every 100 affiliated physicians, which contributes to a 20% loss of a health care system’s annual revenue²
What’s The Solution For My Organization?
For payers and providers, the solution starts with a plan:
- Map your business strategy to your provider data management strategy – are there gaps?
- Create a set of consumer-facing scenarios that require good clean provider information.
- Develop a cross-functional provider data governance working group, to assess the challenges and work toward solutions.
- Identify all the sources of provider data within your organization. What systems do they come from? What data do they include?
- Look for a vendor that can create the single source of truth for your provider data and meet your key consumer scenarios.
Creating An Accurate Central Provider Data Hub
For health plans or providers, InterSystems HealthShare Provider Directory can help you better manage and curate provider data.
For providers:
- Improve patient experience
- Increase in-network referrals
- Provide accurate information for analytics and better-informed decisions
- Comply with regulatory requirements
For payers:
- Improve member experience
- Reduce costs
- Comply with regulatory requirements
- Improve network adequacy determination