For Payers
Provider network management
Ensure data quality, avoid penalties, and contain your costs
Federal and state agencies
Penalize health plans severely for poor provider network management
Members
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.
How to ensure quality provider data
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
HGS Healthcare Technology solutions
Provider network management and intelligent automation solutions are within reach with the HGS Healthcare Technology team.
PROVIDER FORWARD SOFTWARE
A customer relationship management (CRM) app designed specifically for managing a master provider data record
INTAKE PROCESSOR AND INTEGRATION HUB
Components and robotic process automation (RPA) platforms to automate data intake into the CRM system
The intuitive Provider Forward dashboard
Manage your workflow in your customer relationship management (CRM) system. Dashboards are customizable to reflect the data you have, the workflow you use, and the priorities of your team. As shown in this example, provider data are rendered in a variety of chart styles so you can see status at a glance.
HGS Healthcare improves the PDM approach and credentialing and recredentialing turnaround times for a regional health plan
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.
HGS Healthcare improves data accuracy for a physician network provider and, as a result, significantly reduces costs and risks to Star ratings
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.
Related provider network management case studies
Improve provider relationships with the right tools and workflow
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.
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