Healthcare leaders depend on accurate and up-to-date provider information. Without accurate, up-to-date information where it is needed, claims are delayed or paid at the wrong amount, directories are incorrect, mail is returned, research takes too long and call volume increases as members and providers become frustrated. As a result, your costs rise as operations become less efficient – and you become less profitable.

 

Healthcare leaders – including 4 of the top 10 payers, 4 of the top 10 PPOs and many Blue Cross and Blue Shield plans – are already using Enclarity’s information solutions to get the correct, current and comprehensive information about healthcare providers they need. Enclarity’s solutions enable many types of organizations to become more efficient, productive and profitable, including:

 

• Insurers
• Medical
• Auto
• Worker's Compensation
• Disability
• PPO Networks
• Blue Cross Blue Shield Plans
• Consumer-oriented healthcare Web sites
• Electronic Claims Transmitters and Clearinghouses
• Repricing Companies
• Recovery Vendors
• Billing Services
• Hospital Systems
• Large Medical Delivery Systems (labs, chain drug stores, dialysis, etc.)
• Information Exchanges, including RHIOs
• Device and Equipment Manufacturers
• Pharmaceutical Companies
• Retail Pharmacies

 

Powered by Enclarity, businesses in these industries are improving their provider information and their operating margins. With Enclarity, they reduce the costs associated with collecting and maintaining provider information and the downstream costs associated with bad information in areas such as provider directories, claims and network management. Better information enables organizations to reduce administrative costs and increase productivity, improve claims accuracy and throughput, increase member and provider satisfaction, and achieve industry and regulatory compliance for HIPAA, NPI, PDQI, NCQA and more.

 

How can Enclarity help your business? Visit our Value Section to learn the many ways that Enclarity's suite of solutions can increase the return on investment in your operations.

 

In this section, you will find examples of how Enclarity is making a difference for its clients.

 

250,000 Incorrect Provider Records Fixed Overnight is a case history in which Enclarity found over 77 percent of a new client's provider records contained errors and were fixed overnight.

 

No More Dead Doctors in Provider Directories tells the story of how a regional health plan turned to Enclarity to correct the 50 percent error rate in its provider file. In helping the client, Enclarity discovered over 300 deceased providers in their database.

 

Correct and current information is a competitive edge shows how Enclarity is helping InterGroup Services Corporation, one of the nation’s leading regional PPOs, to improve the quality of its provider master file, and relations with providers and plan members.

 

Cutting Provider Verification Costs illustrates how one of the nation’s largest PPOs is using Enclarity ProviderPoint® to automate the updates of its provider file, helping them reduce their research and verification load, saving them significant time and money.

 

Preventive Medicine for Your PDQI Audit demonstrates how Enclarity ProviderPoint is helping Blue Cross Blue Shield affiliates with better results for their provider data audits and operational performance.

 

Savings through faster provider research explains how TC³ Health’s Provider Integrity Program dramatically improved its productivity with Enclarity ProviderPoint for better healthcare claims management.