Healthcare payers are always assessing the adequacy of their provider networks. They’re constantly looking for gaps in coverage, attempting to compare and contrast their internal networks with the competitive landscape. But trying to accomplish this manually is inefficient, costly and often fraught with errors. There must be a more efficient and cost-effective way to get a competitive edge.

 

There is. We can spell the answer in one word: Enclarity.

 

Enclarity ProviderPoint Network Optimization Services and Provider SelectFile® combine the power of our matching and analytic expertise with our Master Provider Referential Database. It’s the most complete and accurate source of provider information. Together, these Enclarity solutions deliver complete insight on overlaps and gaps within multiple networks/databases with a point-in-time file of accurate and timely provider information to fill those gaps.

 

Enclarity delivers multiple analytic and file options to support network optimization, including:

 

• Overlap Analysis
• Gap Analysis
• Competitive Network Intelligence

 

Enclarity’s matching and analytics are more than a simple string compare. ProviderPoint Network Optimization Services deliver a wealth of information that would not be readily apparent without advanced analytics and a referential data source. In addition, Enclarity enhances its robust information with competitive network intelligence from Strenuus, our channel partner. This way, you can be confident that you have the most accurate match and identification of duplicate and overlapping provider records.

 

How Enclarity achieves highly accurate matches and analytics
Enclarity has built and maintains the most robust referential database of provider information, covering all critical types of healthcare providers. We deliver the highest quality information by tapping the most complete and accurate data sources, assembling the right information via our innovative AcuSync process and systematically verifying the results. The result is a storehouse of correct, current, comprehensive information that we call our Master Provider Referential Database.

 

Driving our Master Provider Referential Database is AcuSync, our proprietary methodology for the detection, matching and updating of a provider record. AcuSync uses advanced analytical and database methodologies to match the client’s healthcare provider records (or claims) to the Master Provider Referential Database.

 

With the most robust and sophisticated matching algorithms available, AcuSync automates the matching process, deploying hundreds of rules and techniques on each match to ensure accurate results. The AcuSync process includes file management (formatting and configuration to meet your needs), standardization of data elements (such as name and address), element validation and confirming whether two records represent the same healthcare provider.

 

With AcuSync, Enclarity can match, update, join and augment healthcare provider records (and claim records), as well as identify duplicate records. Once we determine that we have the right provider, we can then link the records across databases to determine whether a provider resides in multiple networks. That’s the power of Enclarity.

 

Overlap Analysis

 

ProviderPoint Network Optimization Services is unique in its ability to compare and identify commonalities in multiple provider networks or database files. Enclarity offers the analytic and matching expertise to detect unique providers across databases even when information is inconsistent or incorrect.

 

When there is a need to compare internal networks to external competition, Enclarity works with its partner Strenuus, to assess the network identifiers.

 

How it works

 

• Client submits its network file, specifying the region and provider types desired for growth
• Using our Master Referential Provider Database, Enclarity compares the client file against the specified universe.
• Enclarity returns a data file of key contact information and identifiers to the client for use in network development

 

Gap Analysis

 

When a healthcare payer wants to enter a new territory or expand its network in a particular area, it typically conducts a marketing campaign to recruit new providers into its network. To most effectively target the desired providers, Enclarity can compare its Master Provider Referential Database with a client’s network and provide a Provider SelectFile record detailing the desired universe of providers that are not under contract for a particular region. Enclarity will provide a comparison of a known universe of providers against what a payer already has in that particular region.

 

How it works

 

• The client submits a network file and defines the specified region and provider types desired for growth
• Using its Master Provider Referential Database, Enclarity compares the client file against the specified universe
• Enclarity returns a data file of key contact information and identifiers not currently in their provider network to the client for use in network development

 

Competitive Network Intelligence

 

When a healthcare payer wants to know what networks its current providers participate in, Enclarity can work with our partner Strenuus to prepare and standardize the client’s provider file. We then forward the file to Strenuus to determine the network affiliations of the client’s providers.

 

How it works

 

• The client submits a network file and defines the specified region and provider types desired for growth
• Using its Master Provider Referential Database, Enclarity compares the client file against the specified universe
• Enclarity returns a data file of key contact information and identifiers including network identifiers to client for use in network development

 

Access the most trusted source of provider information
Just imagine being able to get detailed analytics and new information on providers by type, region and other key dimensions. With that information, you could perform vital research, set strategies and carry out campaigns that would expand and optimize your network, enter new territories and give your business a competitive edge.

 

Now you can. ProviderPoint Network Optimization Services combined with detailed data files from Provider SelectFile, delivers analytics, network coverage and provider information based on your specific information needs.

 

Finally, you can access a trusted source of provider information to enable almost any operational function. From marketing to provider outreach mailing, credentialing support, network gap analysis, planning network growth and more, Enclarity ProviderPoint Network Optimization Services can give you a powerful competitive advantage.

 

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