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Solve the Challenges of
Provider Data Management

Increase Revenue, Reduce Costs, Enhance Experience
female doctor scrolling on a tablet

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

Additional Provider Data Management Resources

Apr 06, 2023
“If you don’t know your inventory, how can you manage your business?”
Product Manager, HealthShare
Feb 21, 2023
Provider Data Management
What happens when you have a bad digital experience with a business or provider? You usually don’t go back. Imagine the type of experience a first-time patient or member has when they visit your website. Usually, they want information, and most often they are looking for a physician or other provider of medical care. Are they able to find what they want? How easily? And are the results accurate and complete?
Apr 05, 2023
Provider Directory
Even though improving the quality and robustness of provider data has become a top priority for healthcare organizations, many still believe their data quality is low.
May 24, 2022
No Surprises Act
New cutting-edge innovations now make it possible to automate the millions of human hours spent cleaning and keying in this data, as well as improve its accuracy.

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