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Creating & Maintaining Accurate Provider Databases

Poor provider data quality plagues the industry.

Payers are continuously challenged by inaccurate provider data due to the continuous movement of the provider community and the complexity of healthcare relationships. Continuous name and address changes, fluid organizational affiliations, multiple PPOs to manage, license number expirations, sanctions, and changing identifiers all contribute to the difficulty of this challenge. Adding to this complexity is the need to handle multiple tax and proprietary identifiers for each and every provider. And since payers store provider data in so many legacy systems, it is nearly impossible to keep a single provider master database clean and accurate across the enterprise.

The most accurate matching. The most comprehensive source of provider reference data.

Health Market Science is uniquely positioned to address these data quality challenges with the combination of the most robust provider-specific matching system, the Data Integration System™, and the most accurate and comprehensive source of provider reference data, the HMS MasterFile™. By using accurate reference data to drive the matching process, the result is dramatically higher match rates and the absolute highest data accuracy.

Data Integration Services™ enable payers to create accurate provider databases by integrating multiple sources of provider information or by cleansing an existing provider master file. These services include:

• Provider Master File generation
• Data matching, cleansing & standardization
• Data de-duplication
• Data enrichment
• Tax id, State license, UPIN, DEA, and NPI validation
• Sanction & criminal verification
• USPS standardization
• Scheduled data updates – ongoing provider file maintenance

Fewer customer service phone calls.

With accurate provider data, payers can dramatically improve claims auto-adjudication first-pass rates, while ensuring compliance with current and future regulations. Customer satisfaction will improve with fewer customer service phone calls required to resolve data integrity challenges. A clean provider database is also the foundation for a successful NPI implementation strategy.