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Data Sheet: Provider Data Management Integrates Seamlessly for Powerful Workflow and Accuracy

Health plans rely on provider data from multiple, disparate sources, resulting in inaccurate results and cumbersome processes.

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For health plans navigating a complex digital landscape, maintaining a single source of truth for provider data is critical. Disparate data sources often result in cumbersome processes and inaccuracies that impact operational efficiency. HealthEdge Provider Data Management offers a robust solution designed to create a streamlined digital foundation. Through native Core Administrative Processing System (CAPS) integration, specifically with HealthRules Payer, this cloud-native SaaS platform ensures data flows smoothly across systems to enhance accuracy and workflow.

Key Operational Advantages

HealthEdge optimizes provider data management through three core pillars, delivering strategic value to health plans:

  • Flexibility: The platform aligns provider data management with administrative systems to significantly reduce manual updates. It features a self-service module for scheduling and delivering data extracts, alongside an observability framework that facilitates troubleshooting and logging of data changes.
  • Accuracy: To improve member experience and ensure regulatory adherence, the solution supports real-time API and event-based distribution. It includes 300+ built-in quality checks and ensures 100% coverage for provider demographics, customer-specific user-defined types (UDT), and benefit network data.
  • Efficiency: The platform ensures scalability and rapid ingestion from trusted sources (including NPPES) to reduce pending claims and authorizations. By automating feedback workflows, health plans can decrease member and provider calls while rapidly developing new extracts without manual intervention.

Discover the HealthEdge Provider Data Management Difference

The integration between Provider Data Management and platforms like HealthRules Payer creates a powerful ecosystem that addresses high-priority challenges for decision-makers. By establishing a reliable data flow, organizations can achieve the following outcomes:

  1. Improve Data Quality: Validate comprehensive data from multiple disparate sources to maintain accurate provider directory listings.
  2. Streamline Financial Operations: Mitigate denials and increase payment accuracy by invoking real-time provider API services within claims adjudication workflows.
  3. Ensure Compliance: Leverage built-in data transformation and validation to support risk management and regulatory adherence.
  4. Enhance Experience: Reduce friction by preventing calls to customer service regarding clarifications or missing information.

By adopting HealthEdge Provider Data Management, health plans can transition from reactive data fixes to a proactive, automated strategy that ensures data accuracy and operational excellence. Explore the Provider Data Management FAQ and detailed data sheet for more information.