Provider Data Remediation

Senior adult African American businessman is pointing at laptop computer screen. He is reviewing financial information with young adult Hispanic businesswoman. The diverse colleagues are in training program during conference or seminar. They are wearing business casual clothing.

Averaging more than 15 years of experience in the healthcare industry, our consultants have worked in a variety of management positions within commercial and government payer organizations, so we understand first-hand your challenges—including competitive pressures, organizational obstacles, and limited resources.

 

Challenges

Before the consulting team could get started, a common understanding of the customer’s provider data and network structure was required. Since there was no existing documentation, the consulting team couldn’t develop a strategy until one was established through research, interviews, and documenting the customer’s internal workflows. In addition, the team also discovered there was misalignment on the prioritization of the work, a high employee turnover rate, and scarce resources available.

Solutions

The team spent the beginning of the project creating detailed documentation for the customer’s provider network and structure, change processes, and comprehensive system network and contract descriptions. After the documentation existed, the team developed a process for team members to follow once data errors were discovered. As part of this process, trainings were held with specific team members to support compliance. After a few ups and downs, the impacted team members bought into the new process and the new process resulted in increased productivity and reduced manual workarounds.

Results

Over the course of the engagement, Change Healthcare Consulting led the effort in the cleanup of 2,000+ data errors. The consulting team also provided the client with a final policy and procedure (P&P) document to ensure the developed process lived on in perpetuity. The P&P document completed an open, correctiveaction audit and outlined continued maintenance policies the customer can follow to ensure their best practices continue forward.

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