Data Sheet: Drive Data Integrity and Reliability with Provider Data Management
Provider Data Management collects, validates and maintains accurate information about healthcare providers that includes demographics, specialties, locations, and network affiliations.
Managing healthcare provider data across siloed systems is often a disjointed process prone to errors, duplicate records, and gaps in information. These inaccuracies can severely impact member outcomes and overall payer performance. HealthEdge’s Provider Data Management solution addresses these challenges by creating a single source of truth that collects, validates, and maintains accurate provider information—including demographics, specialties, locations, and network affiliations.
This cloud-based, end-to-end solution is designed to streamline operations, ensure compliance, and improve data quality for health plans.
Key Benefits of HealthEdge Provider Data Management
Implementing this solution allows health plans to automate workflows and enhance stakeholder satisfaction through:
- Improved Data Accuracy: Achieve 100% coverage for provider demographics and benefit network data.
- Streamlined Operations: mitigate claim denials and reduce pended claims by increasing data accuracy.
- Enhanced Compliance: Support better risk management and regulatory compliance.
- Reduced Administrative Burden: Minimize calls to customer service regarding clarifications or missing information.
- Seamless Integration: Ensure accurate data distribution with native integration into the HealthRules® Payer system.
Core Product Components
HealthEdge’s solution is built on a modern, scalable SaaS platform that includes:
- Ingestion & Match-Merge: Rapidly ingest data from internal and external sources, utilizing match and merge rules to reduce time spent on record maintenance.
- Distribution & Integration: Leverage configurable data distribution and real-time APIs to ensure accurate data flow to downstream systems.
- Enrichment & Workflow: Utilize 300+ built-in quality checks and 1,500+ policy validations to improve the experience for members and providers.
- Platform & Configuration: Access a low-code framework that offers unlimited scalability and customer-extendable data models.
The HealthEdge Difference
HealthEdge differentiates its Provider Data Management offering with a focus on modern, cloud-native technology. The solution provides a turn-key SaaS application featuring continuous upgrades, comprehensive data cleansing validations, and customizable data extracts. By establishing a single source of truth, health plans can drive data integrity and reliability across their entire ecosystem.
