Provider Manager

A provider data management solution for payers that want to store and efficiently maintain accurate provider information to support members, reduce resource needs, and drive network alignment.


MaintainAccurate Provider Data

  • Store data in a common repository shared across departments and business functions Increase transparency and reduce confusion with a single source of accessible provider information.
  • Improve data accuracy by automating your provider information management workflow and reconciling inconsistencies. Keep provider directories current to stay compliant with consumer protection regulations.
  • Improve provider and member satisfaction with access to better information. Support greater alignment between members and high-performance providers, and foster better payer-provider collaborations for new initiatives.
  • Reduce administrative and IT costs with streamlined network management tasks and self-service reporting capabilities. The accessibility of accurate provider directories can result in fewer service calls from members and providers.
  • Enable agility and innovation via automated provider information maintenance, on-boarding, credentialing, servicing, and network design processes. Rapidly roll out and scale new networks and products.
  • Streamline recruiting and credentialing processes with coordinated workflows. Web-based tools can help decrease cycle times, save costs and optimize overall provider satisfaction and engagement.

Streamline Workflows to Improve Data Accuracy

  • Intelligent, single source of provider data

    • Store and manage complex, dynamic provider relationships with a highly flexible, scalable solution that provides the current information you need to support new products, care models, and reimbursement designs.
    • Integrate, reconcile, and validate disparate types of provider data, including affiliations, quality information, demographic profiles, network associations and contract details.
    • Support the needs of both providers and members with accessible, centrally stored data. More accurate information can help members make informed provider choices, while providers benefit from improved payment accuracy.
  • Provider network automation

    • Quickly design and evaluate new network designs to speed your entry into new markets.
    • Leverage various provider information sources to establish network criteria. As providers are added, use the defined criteria to automate the assignment of providers to the appropriate networks.
    • Align your contract terms and reimbursement policies with tailored networks, regardless of complexity level. An integrated, enterprise-wide provider management system helps you drive success with value-based reimbursement models.
  • Smart interoperability

    • Exchange data and intelligently interoperate with a wide range of related systems, minimizing redundant data entry and fostering smarter, more consistent, more integrated business processes.
    • Align value-based networks and products with optimized provider contracts via available interoperability with our Contract Manager product. This alignment synchronizes the work of provider network and contract teams to support new initiatives.
    • Drive operational and audit cost reductions with comprehensive reporting. Expansive inquiry capabilities help you proactively improve your credentialing processes, internal data transactions, and information governance practices.

Our outcomes

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