For Payers
Provider network management
Ensure data quality, avoid penalties, and contain your costs
Penalize health plans severely for poor provider network management
Complain, generate unexpected costs, and even file lawsuits
At the same time, getting the latest information on your provider network has never been more challenging. Health systems are continuing to consolidate, increasing the affiliations between physicians and practices. Many doctors are also experiencing fatigue from constant payer data requests – and resistant to new tools, preferring phone and yes, fax machines.
We provide expert guidance for health plans and a complete set of services and solutions.
PROCESSING PROVIDER NETWORK UPDATES
From multiple sources along with verification outreach
CREDENTIALING AND
RECREDENTIALING
All processing and provider outreach work
PLATFORM EXPERIENCE
CAQH, Cactus, Facets, and more integrate with our CRM-based Provider Forward tool
ONSHORE, NEARSHORE, AND
OFFSHORE
Services provided from locations worldwide
Provider network management and intelligent automation solutions are within reach with the HGS Healthcare Technology team.
A customer relationship management (CRM) app designed specifically for managing a master provider data record
Components and robotic process automation (RPA) platforms to automate data intake into the CRM system
With a growing backlog of provider data to manage, limited quality auditing and inventory tracking to uphold the integrity of the data, the client struggled with the most critical success factor of provider directories: accuracy.
We conducted an indepth analysis of the client’s data quality program, provided a 12-person offshore support team, and applied a purpose-built provider data management (PDM) tool, Provider Forward.
As a provider of physician networks, the client experienced an unsatisfactory number of provider data errors and faced potential impacts to Star ratings as a result of their agents manually keying in data. The client sought, and received, our help in increasing savings and improving the quality of their provider database management (PDM). Using our Provider Forward tool for PDM, we achieved over $800K in annual savings.
Think your provider directories and credentialing workflow could be in better shape? You aren’t alone. A recent HHS survey uncovered data errors in half of the doctor listings for Medicare plans.
Fill out this form to gain access to our provider network management solution overview and see how it can work for your organization.