Significant cost savings through faster provider research

 

With Enclarity ProviderLookup, getting information about providers now takes TC³ Health, Inc. just 30 to 60 seconds to do what used to take 30 minutes or more

 

Overview

 

Founded in 2001, TC³ Health, Inc. (www.tc3health.com) provides healthcare payers with a total claims management solution that seamlessly and electronically integrates claim transaction systems with external loss control programs. Utilizing proprietary claims management technologies, TC³ targets the estimated $250 billion in healthcare claims overpayments to validate payment integrity and maximize savings for healthcare payers. TC³ enables payers to take advantage of state-of-the-art loss control technologies through a single source that prevents claims errors on a pre-payment basis, while reducing paid claims by up to 3-10% annually.

 

The Challenge

 

TC³’s Provider Integrity Program offers the company’s healthcare payer clients with a service that examines and flags questionable or suspect claims before they are paid, so that the claims aren’t paid out in error. The foundation of the program is data analysis and modeling. The staff reviews millions of healthcare claims and performs numerous investigations. Being productive is essential for profitable operations, and significant time savings in claims validation is a recognized benefit.

 

Performing Web-based searches for healthcare provider information is a key component of the TC³ Provider Integrity Program’s investigative process. But finding everything the investigators needed to know about a provider to research potential fraud indicators, such as licensing, specialty, sanctions, identifiers and more, has always meant searching multiple Web sites, such as Google, SuperPages or various state boards. It’s often a slow and incomplete process.

 

"Typically, we have had to go to a minimum of at least three sources for each provider we investigate," explained Jean Lyon, Vice President of Payment Integrity for TC³. “Even then, that would often not be enough. We spent a lot of time going to different Web sites and wading through them to find the correct address, phone and other data for a provider. And even then, we might not find essential information such as the provider’s specialty, NPI or DEA numbers.”

 

"Until now, there was really nothing on the market that could solve our problem", said Lyon. We needed to find a way to make this more efficient."

 

The Solution

 

To address this challenge, TC³ licensed ProviderLookup®, Enclarity’s Web-based, real-time provider information search service. ProviderLookup is an easy to use, powerful solution that enables its clients to find answers fast by accessing Enclarity’s Master Provider Referential Database containing more than 6.5 million healthcare providers. With ProviderLookup, the TC³ team can view the most correct, current and comprehensive information available for each healthcare provider, including individual physicians, physician groups and facilities such as hospitals and other ancillary providers.

 

The Results

 

ProviderLookup has dramatically changed the way that the TC³ provider integrity investigators work.

 

"Researching providers the old way used to take our investigators an average of 30 minutes each," said Lyon. "Now, we can find everything we need about a provider with much better quality in just 30-60 seconds with ProviderLookup. That’s 30 to 60 times faster – an amazing difference."

 

"We really love the ability to look up information on facilities," added Lyon. "Before, it was very time consuming to find any useful information on facilities such as hospitals, and then only if you knew where to look. Often, we couldn’t get the complete information that we needed. With ProviderLookup, we can. It’s the only solution that we know of that can do this. It’s been a huge, huge plus!"

 

ProviderLookup's Web-based interface helped TC³ begin quickly. "With ProviderLookup, getting started was really easy," said Kathy Loesch, Director of Investigative Services for TC³. "No complicated implementation process was required. We needed only a brief introduction, and we were up-and-running right away. The quality of Enclarity’s data is much better than anything we could find. Since we started using ProviderLookup, I’ve gotten great feedback from my staff."

 

Conclusion

 

The improvements in time savings, immediate access, quality of information, ease of use and the ability to look up both individual providers and facilities is making TC³ much more efficient. And their staff could not be more pleased.

 

"We’re getting better information faster," said Lyon. "It’s making my team more productive. One of the investigators is skeptical of changes and hesitant to try anything new. But after using ProviderLookup, even he became a believer. He told me that ProviderLookup works better than anything he could have imagined. It’s really that good!"