Correct and current information is a competitive edge

 

Enclarity ProviderPoint® helps InterGroup Services Corporation dramatically improve its provider master file quality and productivity

 

Overview

 

For over 20 years, InterGroup Services Corporation (http://www.igs-ppo.com) has been one of the most successful regional PPOs in the nation. Serving over 700,000 plan participants and 89,000 providers, InterGroup is the largest PPO network serving Pennsylvania, New Jersey, West Virginia and Delaware.

 

The Challenge

 

With a strong reputation for outstanding operations, InterGroup turned to Enclarity to gain a competitive edge by improving its provider master file and by making credentialing research more efficient. InterGroup realized that the quality of its provider master file was central to its operations. A key component of the company’s competitive strategy was built around increasing accuracy of this key asset.

 

InterGroup’s provider master file impacts its entire operation, from claims management to provider relations, member services, credentialing, finance and more. To fuel further growth, improve productivity and to increase profitability, InterGroup needed an advanced solution to identify duplicate provider records, remove deceased and sanctioned providers, correct inaccurate information and augment missing data. In particular, InterGroup sought the help of Enclarity to clean up the address information for each of the providers in its network, and to give the company a way to keep its information current.

 

InterGroup also needed an accurate tool to assist in the credentialing process. To be able to confirm that a provider is licensed is a critical component of accurate credentialing. With current information on license status, InterGroup would have an important sales tool for its network.

 

The Solution

 

Maintaining the company’s high standard of provider data quality is a big priority for InterGroup. It’s one of the main reasons why InterGroup selected Enclarity to help the company cleanse and augment its provider master file, improve its provider directory and enhance relations with its providers.

 

After consulting with InterGroup, Enclarity utilized its ProviderPoint® data verification, cleansing and augmentation solution to improve the accuracy of InterGroup’s provider master file. ProviderPoint is a proven, powerful hosted solution that offers healthcare payers a systematic way to keep their provider information accurate and up-to-date while saving the cost and time of a significant ongoing internal data quality project.

 

At the heart of ProviderPoint is Enclarity’s Master Provider Referential Database, which uses Enclarity’s innovative AcuSync® process to leverage thousands of referential and transactional data sources. AcuSync uses advanced analytical and database methods to efficiently and reliably standardize, match and join data from different sources, and then produce a provider profile that contains the best available information. In addition, Enclarity verifies demographic information via phone calls to ensure that the information is of the highest quality.

 

The Results

 

In just a few months of use, ProviderPoint has helped InterGroup be more productive by:

 

• Significantly improving the completeness, accuracy and timeliness of its provider master file. With ProviderPoint, InterGroup can quickly identify and remove bad and duplicate addresses. ProviderPoint also helps InterGroup reduce time on the phone assisting plan participants, reducing costs and increasing productivity.
• Verifying that each provider is licensed. So far, ProviderPoint has helped InterGroup identify and remove 20 sanctioned doctors from its network. This is important for both legal reasons and for the ongoing satisfaction of InterGroup’s clients, healthcare payers, as well as the payer’s plan members.
• Assisting in clean-up of Tax Identification Numbers (TINs). Enclarity improves InterGroup’s claims processing by enabling the company to replace Social Security Numbers (SSNs) with the provider’s TIN when information containing SSNs is received.
• Reducing returned mail. ProviderPoint has significantly decreased InterGroup’s returned mail backlog, freeing its staff for other important duties.
• Improving payer, provider and member relations through better communication.
• Decreasing claims processing time and cost. InterGroup expects to see continuous reductions in the volume of rejected claims requiring research.
• Reducing provider-related questions from payers and plan members. InterGroup frequently answers phone inquiries from payers on behalf of the payer’s members regarding status of providers (for suspended and terminated licenses). The company also receives calls from patients considering a provider listed in the InterGroup provider directory. With significantly improved provider information from ProviderPoint, InterGroup’s provider directory is more accurate and complete. The result: greatly reduced call volume as well as improved payer and plan member satisfaction.

 

Conclusion

 

“We’re really proud of the quality of our provider master file and our level of provider relations,” Greg explained. “The last thing we need is to have a sanctioned provider on our network, as it could reflect poorly on us. ProviderPoint is helping us dig deeper, and improving the accuracy and timeliness of our network. Being able to stay current on the status and correct address of our providers means a lot. In a short time, Enclarity has made a noticeable difference for InterGroup.”

 

ProviderPoint has not only helped InterGroup improve its provider directory, its claims operations and its credentialing process. The information that Enclarity offers has given InterGroup new insight on how to improve its operations.

 

“Now that we have this information, we are reviewing our processes,” said Greg. “If we discover a provider in our network is sanctioned, do we want to keep them in our network? Are these sanctions relevant to our patients? Enclarity has opened some interesting questions based on what we have discovered. If we give the name of a sanctioned provider to a patient, we could be liable. So, Enclarity has helped open our eyes to put greater scrutiny on our network, and give us critical insight on how and where to improve the quality of our network.”

 

Confident that its provider master file is accurate and up-to-date, Greg feels that ProviderPoint gives InterGroup a competitive edge.

 

”Our provider master file touches everything - including operations, claims and sales,” said Greg. ”So, the better our provider information is, the more valuable we become. The provider information that we get from Enclarity is very comprehensive, and their response is always extremely fast. It’s really making a difference for us in providing top quality service, and helping InterGroup be more competitive in the marketplace.”