Healthcare Credentialing News & Insights

Provider Data Management February 2017

25% of Provider Data Became Obsolete in 2016. Don’t Let that Happen in 2017.

Provider Data Management February 2017

25% of Provider Data Became Obsolete in 2016. Don’t Let that Happen in 2017.

Fact: Your business runs on data. That data affects your business every day.

Obsolete provider data is an industry-wide problem. It’s likely that a good portion of your data is already outdated, and another 2% will become outdated every month, making it less useful to you and your members every month.

You wouldn’t be okay with your investment portfolio losing 25% annually. And you shouldn’t stand for losing a quarter of your data annually. Your data is an investment. Guard it accordingly.

Where bad data hurts most:

Billing: When your addresses aren’t correct, billing becomes 5x more expensive.

If you’re like most healthcare organizations, your data contains large volumes of duplicate or inaccurate addresses. During our recent data cleanup work with a new client, we improved their addresses by 10% by finding, validating and correcting their addresses with national databases.

Billing

Provider directory: When your directory isn’t updated, member trust deteriorates.

Provider data — such as location and phone number — not only directly impacts your ability to remain compliant and avoid hefty fines, it also impacts your service to your members. If your outdated data is being used to populate provider directories, you run the risk of angering members who rely on that data to make appointments and get directions. (Hear from one member who lost trust in her health plan because of bad provider directory data).

Business intelligence: Network adequacy begins with truly understanding your roster.

An accurate picture of your network is essential. So is being able to search by each piece of data such as specialty, language, malpractice thresholds, etc. With access to useful data you can make decisions about your network based on the actual providers in your current network, not the providers that were in it two months ago, but who may or may not still be there.

The bottom line: All integrity is lost if good and bad data are stored together in the same container.

Accurate provider data is essential, and that starts with the credentialing process.

We work with our clients to not only clean up their data but also to keep it accurate. Here’s how we do that:

  • You’re the expert on your network. We are the data experts. We partner with you to clean and norm your data to make it useful to you. During the cleanup process, we standardize records (eliminating duplicate addresses, validating current addresses and correcting typos) and structure your data in a way that reflects real life relationships and allows us to maintain the accuracy of your data. Your data will be both searchable and usable.
  • Our platform keeps your data accurate by automatically matching data against all primary sources (and most secondary), backfilling and correcting information that will cause gaps in compliance.
  • Our system also alerts you when credentials expire or any compliance concerns pop up with an individual provider.

 


 

“We’re happy to be working with an innovative company like CredSimple. Our companies are aligned in making data quality and compliance our top priorities.”
– Clover

Learn more