Silos Are for Grain, Not Provider Data

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It’s no secret that healthcare has a disparate provider data problem. For payers, provider data issues start at enrollment and continue throughout the provider lifecycle, impacting everything from credentialing to the provider directory.

Payers often incorrectly assume that the absence of a prior issue implies that a provider's credentials are clear for the foreseeable future. This creates a sort of false confidence when in reality, provider data is dynamic and should be treated as such.

Most payers have evolved their processes to include automation, a meaningful step forward from storing provider data in a manilla folder and making updates by hand. Yet challenges remain, and data still goes stale all too quickly.

At a basic level, provider data determines whether a healthcare provider is eligible to provide care to members. The integrity—or lack thereof—of each payer’s provider data impacts whether the communities they serve are able to seek care from qualified, eligible providers.

“At the end of the day, payers are just trying to engage their provider networks to provide the effective and safe care that their members should be able to experience. So as difficult and complex as it is for these payer organizations to navigate provider data, it creates all kinds of problems in the provider experience and the member experience, too.”

Why Provider Data Matters So Much

—Mike Wirth Chief Commercial Officer, ProviderTrust

Breaking Down Barriers to Better Data

Though there’s a great need for provider data centralization across the industry, there’s no easy solution. Data exists in silos in the healthcare industry at large, and the problem of siloed data exists within most payer organizations, too. These silos, whether external or internal, compound the challenges payers face when it comes to accessing, verifying, and utilizing provider data in all the right places.

Internal Barriers

External Barriers

Without a central source of truth for live, verified provider data, payers face obvious hurdles to accessing the data they need.

Even leading sources like NPPES or CAQH can contain self-reported data

Data fields and shorthand terminology vary from source to source

The frequency of updates varies based on the primary source

Crucial data is spread across hundreds of disparate primary sources

Many tech solutions aggregate data without verifying it at the primary source

DynamicNPI is the payer industry’s most comprehensive source of verified provider data, connecting disparate primary source information directly to NPI numbers.

The dynamic nature of provider data calls for dynamic processes that don’t allow data to go stale. ProviderTrust’s new payer-focused solution, DynamicNPI™, does exactly that by connecting the dots between disparate primary sources to gather real-time provider data with just an NPI. This innovative data model creates a fully verified profile for each provider that’s accessible using their NPI, giving payers real-time access to the data they need to determine whether a provider is eligible to deliver care. This includes state license verifications, board certifications, DEA and/or CDS certifications, federal and state exclusion/sanction checks, and more. DynamicNPI was built to enable interoperability, with a turnkey API that gets the right data into the right places within your organization, even when teams use different workflows. Instead of adding another technology platform to your plate, DynamicNPI delivers the up-to-date, verified data you need wherever you need it.

These barriers, both external and internal, can’t be solved all at once. It’s important to prioritize which challenges affect your organization most and start taking steps toward overcoming them. If you find that you’re working with stale, inaccurate, or incomplete data, make a plan to prioritize data integrity improvements before you implement a new technology platform to connect your organization’s existing data. Once your data integrity is in order, you can begin to focus on promoting interoperability across the organization.

“So much data is siloed. It works well for grain, but not necessarily for provider data.”

Why Provider Data Matters So Much

For most payers, internal disconnects amplify the issue of messy data from outside the organization.

A lack of data integrity affects provider directories and the member experience

Credentialing backlogs contribute to a negative provider experience

Siloed departmental accountabilities can perpetuate the status quo

Workflows vary between departments, making data integration difficult

Legacy tech solutions weren’t built with interoperability in mind

—Mike Wirth Chief Commercial Officer, ProviderTrust

Working Toward a Solution

Live, Verified Provider Data at Your Fingertips

Delivered directly within your workflow of choice via API

Hands-off NCQA-certified automation you can trust

24/7 access to up-to-date, verified information

Speed up time to credential, expediting the path to revenue

Access the verified data you need in 0.5 seconds

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