How to Improve Provider Relationships with a Next-Generation Provider Data Management Solution
For many payers, maintaining accurate provider information is complicated. Managing disparate data sources, analyzing information, and reviewing existing records can feel like trying to solve a puzzle with mismatched pieces.
But establishing and maintaining updated provider information is key to essential health plan operations. An accurate database ensures claims are paid correctly and on time, helps members access timely care, and enables regulatory compliance for health plans.
Adopting next-generation Provider Data Management tools can make it easier for health plans to streamline data management workflows, improve outcomes, and foster stronger relationships with providers and members.
The Pitfalls of Outdated Provider Data Management
Healthcare payers spend an estimated $2.1 billion every year to maintain provider information—and yet, almost half of Medicaid Advantage online provider directories had at least one inaccuracy.
Legacy solutions and outdated workflows can cause unnecessary challenges for payers. Common practices like using disjointed digital solutions and reliance on manual updates can lead to:
- Administrative friction caused by duplicate or outdated records
- Higher operating costs from addressing claim errors
- Member and provider dissatisfaction due to unreliable directories and claims processing delays
- Missed opportunities for payers to improve care coordination and delivery
With healthcare payers spending billions annually on maintaining provider directories, the need for streamlined, accurate, and scalable solutions is urgent.
3 Ways to Enhance Provider Relationships with Advanced Data Management
Strong partnerships between health plans and providers drive better member outcomes and operational success. Leveraging a modern Provider Data Management solution empowers health plans to strengthen these vital relationships.
1. Maintain Accurate Information About Your Provider Networks
Providers expect health plans to maintain accurate databases. Advanced Provider Data Management solutions facilitate data accuracy by:
- Reducing duplicate records and incorrect data entries
- Enabling stronger compliance with healthcare mandates like the No Surprises Act and interoperability regulations
- Improving navigation for members, increasing trust and reducing provider abrasion
2. Streamline Administrative Processes
Administrative waste can strain provider relationships, especially when inefficiencies impact finances. Provider Data Management tools help eliminate errors and expedite workflows, saving valuable time for healthcare administrators and providers.
- Reduce manual reconciliation with intelligent data mastering features
- Automate provider terminations or reinstatements, ensuring no outdated or orphaned data in the system
- Free up resources by removing repetitive manual tasks, allowing employees to focus on high-value priorities
One case study, featuring the Public Employees Health Program (PEHP), highlighted how the HealthEdge® Provider Data Management solution helped eliminate the manual review workload of five full-time employees. This allowed PEHP to reallocate their valuable time to higher-value and higher-impact tasks.
3. Enhancing Provider Trust and Transparency
Provider relationships thrive on transparency. Provider Data Management systems empower health plans to:
- Leverage accurate, real-time data for provider directories that improve member access to timely care.
- Streamline claims processes, bolstering trust between payers and providers by reducing payment delays and inaccuracies.
Broader Business Benefits of Optimized Provider Data Management
Beyond enhancing provider relationships, next-generation Provider Data Management solutions offer business-wide advantages in today’s digital-first era.
Greater Operational Efficiency: Centralized and automated data ingestion, review, and editing processes reduce the reliance on manual review, which can be slower and more error prone. Advanced matching algorithms within Provider Data Management solutions reduce the risk of errors, deliver faster updates, and work within an integrated digital ecosystem, leading to leaner operations and reduced costs.
Improved Member Outcomes: If health plans don’t provide accurate provider directories, it’s that much harder for members to access timely and in-network care. Ensuring online provider directories are up to date can help members get the right care in less time—and without the frustration of unexpected out-of-network bills.
Future-proofing Against Regulatory Change: Healthcare regulations are continuously evolving, and compliance is non-negotiable for payers who want to avoid hefty fines. Advanced Provider Data Management platforms are tailored for regulatory adaptability, helping ensure health plans stay prepared for what’s next.
What Makes a Next-Generation Provider Data Management Tool?
Modern Provider Data Management platforms are built for efficiency and scalability. These advanced platforms combine innovative automation capabilities and seamless data integration to create a single source of truth. They address the most pressing challenges with features designed for health plans operating in a highly competitive and regulated industry.
What features matter most when your health plan is assessing Provider Data Management solutions?
- Data Automation: Pre-built and customizable “match and merge” rules reduce manual data entry and reduces update time.
- Real-Time Updates: Event-based APIs notify users of provider status changes to help ensure data is accurate and consistently updated.
- Native Quality Checks: Built-in data validation ensures reliability across your entire ecosystem. The HealthEdge® Provider Data Management solution includes more than 300 built-in data quality checks.
- Cloud-Native Scalability: SaaS architecture enables your health plan to meet the needs of growing provider networks and member populations.
Preparing for the Future with Provider Data Management
Healthcare is rapidly evolving, and staying competitive means adopting innovative, scalable solutions like next-generation Provider Data Management tools. By streamlining operations, enhancing provider relationships, and prioritizing compliance, health plans can build a future-ready foundation.
Learn more about how the HealthEdge Provider Data Management platform is leading the way in ensuring provider data integrity. Read the data sheet.
