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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.

Liza F., Credentialing and Technical Solutions Supervisor

Staying compliant across your provider networks shouldn’t be complex.

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Regulatory complexity and disparate provider data make compliance hard to achieve.

Provider data across your health plan is fragmented.

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. 

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Custom monitoring requirements

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.

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Maintaining provider directory accuracy is a constant challenge

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.  

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Gaps and inconsistencies in primary source data increase compliance risk

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.   

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Say hello to Dash.

Total Compliance
Total Compliance
Achieve compliance confidence for every provider and line of business.
Accurate Provider Data
Accurate Provider Data
Our smarter data fills in the gaps at the primary source to complete your provider record.
Smarter Monitoring
Smarter Monitoring
Our matching algorithms spot Medicare/Medicaid exclusions no one else can.
Actionable Insights
Actionable Insights
Manage your entire health plan’s provider directory from one dashboard.

Top Areas of Risk for Health Plans in 2020

Find out how the COVID-19 pandemic has created new and expanded risk for payers in 2020.

Resources to help Provider Operations teams grow & succeed.

The ABCs of OIG Exclusion List Monitoring
The ABCs of OIG Exclusion List Monitoring
Learn the basics of OIG exclusion lists, compliance best practices, and a brief description of…
CMS, Compliance, Exclusions, Health Plan, Human Resources, OIG, OIG LEIE, Procurement, SAM

It’s time for smarter provider network monitoring.

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ProviderTrust | Our Story
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