An end-to-end solution for improving provider data accuracy
Overview
The accuracy of provider data is an ongoing, industry-wide challenge. It has been estimated that almost 50% of provider directory entries are inaccurate. Not only is this problem widespread, but it also heavily impacts the member experience and can lead to surprise billing or poor access to care. In addition to the member experience, poor quality provider data costs organizations upwards of a staggering $2B a year, impacting operational efficiency, profits, quality of care, and patient outcomes. Many of these costs are borne internally by the health plan and stem from downstream impacts of poor provider data including member and provider dissatisfaction, claims impact (overpayment) and compliance penalties.
While some of these accuracy issues are due to reconciliation issues between plans and providers, most are a result of simple human error. Large health plans typically receive thousands of provider directory updates every single day. These updates come in many, disparate formats, from highly complex and sophisticated provider rosters to ad-hoc, phone calls, e-mails, and even faxes. With so many updates, formats, and no clear source of truth, it is not surprising that provider data is riddled with errors.
Our team of engineers and data scientists have developed a fully automated, scalable solution to vastly improve provider data accuracy and operations for health plans. Our solution has improved simulated CMS style audits in excess of 25% and also allows plans to automate provider data updates to meet the upcoming “48-hour rule” that is part of CAA compliance.
Testimonials
