For Payers

Provider network management


Ensure data quality, avoid penalties, and contain your costs

It’s critical that your provider data is correct and up to date

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.

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PROCESSING PROVIDER NETWORK UPDATES

From multiple sources along with verification outreach

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CREDENTIALING AND
RECREDENTIALING

All processing and provider outreach work

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PLATFORM EXPERIENCE

CAQH, Cactus, Facets, and more integrate with our CRM-based Provider Forward tool

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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.

Provider Data Dashboard
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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.

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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.

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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.

Fill out this form to gain access to our provider network management solution overview and see how it can work for your organization..


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