Provider directories and the data that power them must evolve to meet the needs of both changing regulatory requirements and an increasingly digital member base.
In this guide, we define how a proactive approach to provider network eligibility helps payers create greater efficiency and profitability within government programs, reduce the risk of ineligible claims, and improve interoperability.
PECOS plays a critical role in facilitating communication and data accuracy between providers and CMS. It powers several datasets indicating providers’ statuses and standing with CMS.
The Interoperability Rule, currently slated to go into effect in 2021, impacts provider network data for health plans in addition to significant implications for patient health data requirements.
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.
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.
Join us for a quick tour of how we help our nation’s largest health plans ensure continuous provider network eligibility and solve the long-standing issues of the health plan industry.
As the meaningful data surrounding the mid and long term effects of the COVID-19 crisis begin to come into focus, one aspect of the dramatically impacted healthcare industry is becoming clear: growing Medicaid MCO enrollment.
Claims leakage in non-par networks should be on the radar of health plan leaders as an important and solvable challenge. Find out why.
Learn the best practices for exclusion and preclusion monitoring for pharmacies and prescribers.