The speed at which ProviderTrust’s automated monitoring catches and verifies exclusions is a huge value, saving us the time and cost of manual verification and overpayment recovery later.
Staying compliant across your provider networks shouldn’t be complex.
Regulatory complexity and disparate provider data make compliance hard to achieve.
Provider data across your health plan is fragmented.
Ongoing compliance across your providers is becoming increasingly complex. We’ll design a monitoring solution that incorporates a holistic view of compliance across your providers to include exclusions, sanctions, NPI status, licensure status, DEA registration, and providers’ historical data.
Customizing monitoring requirements by a line of business is tedious.
Managing various state and federal billing compliance requirements across each provider network and each line of business is complex, time-consuming, and risky. We design tailored monitoring solutions based on your custom requirements to ensure billing accuracy and compliance across each business line and provider network.
Maintaining provider directory accuracy is a constant challenge.
Recent audits confirm that maintaining an accurate provider directory is becoming increasingly difficult. The latest 3-year audit by CMS found nearly 50% of providers across MA plans had at least one inaccuracy. We leverage our enhanced provider data to establish a monitoring baseline for your directory that includes ongoing NPI, licensure, sanction, and exclusion status.
Gaps and inconsistencies in primary source data increase compliance risk.
It’s no secret that managing documentation from various primary sources is disparate, challenging, and resource intensive. We enhance primary source data to catch exclusions other solutions never find, such as name changes, changing states and switching addresses, new or former licenses issued, or DBA entity incorporations for excluded individuals.
Say hello to Dash.
Our smarter data fills in the gaps at the primary source to complete your provider record.
Top Seven Monitoring Challenges for Health Plans
Smart, integrated monitoring is the key to mitigating risk within provider networks. As health plans transition to ongoing eligibility monitoring, these are the top challenges they face.
Resources to help Provider Operations teams grow & succeed.
How to Improve Ownership of Provider Data
In this post, we’ll provide a framework for refining ownership of provider data and eligibility monitoring in your organization and explore the most common accountability structures we see with health plan clients.
Stay up to Date
Get the latest healthcare compliance news, advice from industry experts, and all things related to OIG exclusions delivered straight to your inbox.
Evolution in Medicaid Managed Care
In this conversation with data and policy analyst Allan Baumgarten, we discuss the key differentiating areas of procurement, contracting, and oversight, and where these may be headed.
