Efficiency, accuracy and automation. These are three important goals for any claims operation. The more claims can be adjudicated automatically, the lower the cost, the higher the productivity, accuracy and profitability. Poor provider data quality significantly affects your claims operation - when provider information is outdated or inaccurate, a growing volume of claims fall out of the automated process and require manual intervention or adjustment. As a result, work backs up, errors and rework increase, and penalties can be incurred.

 

The quality of your provider information is critically important for your business and keeping it up to date is essential. But it often feels like running on a treadmill: you go faster and faster, but never seem to get anywhere. Throwing more of your staff at the problem can work for a while, but the minute you redirect the resources, you start to lose ground. And you'll pay the price in terms of higher operating costs. If you could find a better way to clean, augment and maintain your provider files, think of the time and money you could save, and the other things you could do with your staff's time.

 

Like fresh flowers or a loaf of bread hot from the oven, even the newest provider data quickly becomes stale. The typical provider file has 30-40% missing or incorrect information. Trying to correct outdated provider information manually is complex, labor-intensive and expensive. On average, it takes 30-60 minutes to research, correct and update an individual provider record, and involves people across many departments. Often, there is a significant lag between when the provider data operations group is notified of a change in a provider's information and when it can be corrected. The delay resulting from research and manual updates affects the prompt payment of claims and provider contract updates, which can sour relationships.

 

For example, consider an organization with 100,000 providers, and average provider file accuracy. If this organization assigned ten people to clean up that file, it would take them an entire year to research and correct the incorrect records. As soon as they finished they would have to start over again, as the rate of decay for demographic information exceeds 2% per month. And, they would also have to tackle the new errors introduced via manual data entry.

 

All in all, a do-it-yourself approach to provider information can be a huge drain on your resources. In addition to doing all those manual updates, you need to be expert in finding the right information sources, acquiring the rights to use them and monitoring changes. You also need to be expert at the sophisticated statistics behind fast, accurate matching.

 

If only there were an advanced, automated and intelligent way to standardize, cleanse and augment incorrect and outdated provider information, and keep it that way. Imagine the savings in time and being able to deploy your staff to tasks that could make you money. The good news is that there is such a solution. We call it Enclarity. By offering a rapid and highly accurate way to cleanse, standardize and augment provider files, and keep them that way with our ProviderPoint® solution, we're revolutionizing provider data maintenance.

 

Our ProviderPoint family has grown to include specialized solutions for improving claims management. ProviderPoint for Claims Cleansing lets healthcare payers automatically validate and correct key issues on claims, and stay alerted that research is needed about the provider (rendering, billing or referring) as each claim is submitted. Another Enclarity solution, ProviderPoint for Claims Indexing, identifies and links unique healthcare providers across claims stored in databases or a data warehouse, regardless of changes to name and business affiliation, TIN, Provider ID, practice or billing information over time.

 

For those needing to research individual providers, our Web-based ProviderLookup® solution makes research for claims, adjustments and returned mail a snap. ProviderLookup enables customer service teams to rapidly assist members and providers, helps provider operations staffs verify and update records, and marketing teams accurately update databases for returned mail. Enclarity Provider SelectFile® gives provider data operations teams subscription access to our Master Provider Referential Database, for correct, current and comprehensive insights and details on over 6.5 million providers. And Enclarity NPI Match® significantly eases the task of compliance with the National Provider Identifier.

 

Enclarity solutions can help you solve one of the big stumbling blocks to efficient operations. By outsourcing your provider information to the industry leader, you can transform your information quality and realize new value across your organization. Your operations can become more efficient, and you can redeploy your staff to tasks where they can help you be even more efficient and profitable. Imagine what Enclarity can do for your operations. It's not a dream. It's not the future. Better provider information. It's available right now. From Enclarity.

 

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