|Case History 5|
Preventive medicine for your PDQI Audit
A leading Blue Cross Blue Shield plan uses Enclarity ProviderPoint® to improve its healthcare provider information and PDQI score
The Provider Data Quality Index (PDQI) is a critical Blue Cross Blue Shield Association measurement standard with which all Blue plans must comply. The PDQI measures, among other things, the accuracy of provider information displayed in provider directories and Web sites. Each Blue planís provider records (that are housed in the Provider Data Repository for inter-plan use) are audited quarterly. The accuracy results are then compared with other Blue plans (by peer group). The Provider Data Audit, worth 45% of the overall PDQI, measures how useful provider information is to Blue plan members.
After several less than satisfactory PDQI audits, a leading Blue plan sent Enclarity a sample file containing 50 provider records. These were identified as having incorrect information when audited for provider data quality based on the Blue Cross Blue Shield Association guidelines. The Blue plan wanted to see if Enclarity could have helped it with those records, and thereby improve its PDQI score.
We used our ProviderPoint® solution to standardize and match the providers in the file to the Enclarity Master Provider Referential Database, and to find correct, current information for those providers.
Based on the ProviderPoint run, using Enclarityís ProviderPoint solution would have:
The combination would have a significant positive effect on the planís PDQI score.
The results of the analysis were:
Raising and maintaining the PDQI score to an acceptable, and beyond that, to an exemplary level, is a key priority for a Blue plan. But itís an expensive effort to proactively validate all providers in a directory on a routine basis via phone, mail and manpower. Enclarity ProviderPoint can be a powerful solution for Blue plans, because it routinely reviews provider files against a robust source of continuously updated provider information. Quite simply, Enclarity ProviderPoint is the most cost-effective way to maintain the correct, current and comprehensive provider information you need to achieve and maintain exemplary PDQI scores.