HealthEdge Provider Data Management
Optimizing operations with accurate and reliable provider data
Health plans often rely on multiple, disconnected sources for provider data - leading to inaccuracies, duplication, and operational inefficiencies. A unified, trusted source of provider data is critical to drive accuracy, efficiency and digital transformation.
HealthEdge Provider Data Management platform creates a single source of truth for provider data. Built with native integration with Core Administrative Processing System, HealthEdge Provider Data Management streamlines ingestion and enrichment using a Generitive AI-powered framework and distributes cleansed data through a configurable, event-based, realtime API architecture. This enables real-time accurate data to flow across the HealthEdge solution suite and the broader heath plan ecosystem.
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HealthEdge Provider Data Management Solution Suite
"I'm a little embarrassed to say this, but we manage our provider network on a spreadsheet--that is our primary source of truth. And we employ four people that do this full time. It's prone to error."
– HEALTH PLAN BUSINESS SYSTEMS EXECUTIVE
With Provider Data Management, HealthEdge offers a scalable solution that surfaces comprehensive, real-time data that health plans can use to automate workflows and improve stakeholder satisfaction.
Ingestion and Match-Merge
Reduce hours spent addressing changed records:
- Rapid ingestion from multiple external and internal trusted sources
- Customer-defined provider master identifier -Match and merge rules
Distribution and Integration
Ensure accurate data distribution with HealthRules Payer
- Configurable data distribution and native core administrative processing system integration
- Self-service module to configure, schedule and deliver extracts -Real-time API and event-based distribution
Platform and Configuration
Achieve unlimited scalability with cloud-native SaaS platform
- Customer-extendable data model
- -Low- or no-code framework to configure
- Automated source intake and distribution, with ability to suppress data as needed for downstream consumption.
Enrichment and Workflow
Improve experience for members, providers, and your team
- 300+ built-in quality checks
- Third-party validations
- Web application with built-in workflow module
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Optimize Operations with Next-Generation Provider Data Management Tools
Learn how utilizing modern, scalable, cloud-based systems can enhance the integrity and reliability of provider data from multiple sources, optimize capabilities and reduce friction between payers and providers.
RegisterFAQ?
What security and data protections does HealthEdge Provider Data Management support?
• HealthEdge Provider Data Management includes role-based security for critical data elements. The data model complies with applicable regulations like HIPAA and HITECH, ensuring protection of sensitive provider information.
• HealthEdge Provider Data Management employs a security-first approach, integrating a variety of security measures to protect sensitive information. Beyond role-based access, HealthEdge Provider Data Management ensures that all sensitive data is encrypted at rest using AES-256 encryption.
• HealthEdge Provider Data Management natively supports and requires single sign-on for authentication.
This allows your organization to enforce login rules like account lockout and multi-factor authentication (MFA).
• Annually, a third-party conducts regular penetration tests to improve the platform’s
security posture.
Does HealthEdge Provider Data Management also integrate with GuidingCare, Wellframe, and HealthEdge Source?
Yes, HealthEdge Provider Data Management is designed to integrate seamlessly across the HealthEdge solution suite, including GuidingCare®, Wellframe, and HealthEdge SourceTM. HealthEdge Provider Data Management supports data distribution through realtime APIs and event-driven messages. Integration is enabled via the HealthEdge Integration HUB, built on a publish-subscribe model. This architecture ensures consistent synchronization of provider data across systems, enabling streamlined operations and enhancing stakeholder satisfaction through improved data accuracy and accessiblity.
How are you ensuring data quality and integrity?
• HealthEdge Provider Data Management’s approach to ensuring data quality is robust. It includes over 300 built-in quality checks,
which are complemented by third-party validations [e.g., National Plan and Provider Enumeration
System (NPPES)] and match and merge rules to standardize and validate incoming provider data.
• HealthEdge Provider Data Management’s dashboard enables administrators to monitor data quality in real-time and ensure
ongoing compliance with regulatory requirements such as the No Surprises Act.
• Additionally, validation rules and quality checks are applied to all incoming and outgoing data
to maintain high-quality provider records.
How do you handle exceptions or incorrect data?
• When incorrect or conflicting data is identified, HealthEdge Provider Data Management provides a comprehensive data correction
and editing interface. Users can easily resolve discrepancies using pre-configured match and
merge rules, or manually edit data via the platform’s intuitive portal.
• HealthEdge Provider Data Management also provides out-of-the-box dashboards for monitoring data quality, ensuring that any
issues are identified and addressed quickly, minimizing the impact on downstream systems.
Can you support migration from a different provider data management solution?
Yes. HealthEdge Provider Data Management facilitates the migration of provider data from legacy systems through a one-time full
load of data, allowing for a seamless transition. Once the initial data migration is complete,
HealthEdge Provider Data Management supports incremental changes and near real-time updates, ensuring that data remains
up-to-date and accurate throughout the transition process.
• The solution’s configurable business rules and scalable data intake model make it ideal for
migrating data from a wide range of previous solutions.
Can I configure business rules?
HealthEdge Provider Data Management offers highly configurable business rules for various aspects of data management, including match/merge processes, data validation, and data distribution. These rules can be tailored to meet the specific needs of your organization, ensuring that data flows seamlessly between internal systems and external partners. The platform’s low/no-code framework makes it easy to configure and implement business rules without requiring extensive technical expertise.
What is the timeline for implementation?
• Thanks to its low/no-code framework and pre-configured workflows, HealthEdge Provider Data Management is designed for rapid
implementation.
• The solution allows for incremental data loads and real-time updates, ensuring a smooth and
quick setup process.
Are there cloud options as well as on-premise options?
The solution is cloud-native (hosted on Microsoft Azure) and SaaS-based, providing all the benefits of scalability, security, and high availability without the need for on-premise deployment.