Consolidate provider data and contracts into a single source of truth.
Automate end-to-end provider lifecycle.
eProviderSync™ is a patent-pending SaaS based provider and provider contract management solution. It automates the end-to-end provider life cycle, so you can create a single source of truth for providers.
The only solution developed by health plan professionals.
House all types of providers and extend the provider models to include the innovative affiliations demanded by Value Based Purchasing and Contracting.
Improve Net Promoter / Customer Satisfaction scores.
eProviderSync™’s ability to improve data accuracy ensures consistency of provider data and contracts across the health plan. This further improves the net promoter and customer satisfaction scores.
Why eProviderSync™ ?
eProviderSync™ improves the speed, accuracy, compliance and cost-effectiveness of provider data and contracts.
An end-to-end solution for eliminating disparate legacy systems and error-prone processes.
Simplify configuration of providers and provider contracts with intelligent decision support for provider data, directory, network and relations teams
Comply with configurable guardrails for regulations, business policy via centralized business rules
Flexibly capture ALL types of providers and contracts:
Commercial and Government
Standard and Custom
Ancillary (Dental, Vision, Pharmacy, STD, LTD, Life etc.)
Engage all stakeholders via integrated use-case specific workflows vs. emails
Incrementally build providers and contracts with inputs across teams
Annotate and track changes for regulatory and business communication content from single source
Robust audit trails enable compliance to regulatory agencies and external auditors
Generate all communications document materials from the single source – provider notifications, credentialing, authorizations, contracts
Seamlessly integrate provider and contract information via ETL, Web API or Batch files to/from:
CRM (Salesforce, MS Dynamics, Siebel)
Portals (Member, Provider, Customer Service, Broker, Agent)
Authorization / Referrals
MDM (Master Data Management)
Modeling tools (Quest Analytics, Homegrown)
Frequently Asked Questions (FAQ's)
Please click on question to explore more
A. The management of Provider networks by Health Plans follows a series of steps starting from Provider contracting and onboarding to credentialing, claims management, value-based payments, and much more. The process of managing end-to-end Provider lifecycle is known as Provider Lifecycle Management.
A. Our solution, eProviderSync™, automated the Provider lifecycle by ingesting your provider data from your internal and external sources to create the single Source of Truth for all provider information. From here, you can configure your data to comply with guardrails for regulations and business policies via centralized business rules. With eProviderSync™, you can collaborate with all stakeholders to manage your provider data with robust workflow capability, including routing, notifications, and a logging function to track all changes.
A. Challenges with traditional Provider data management processes:
- Rigid systems that force you into their workflow, not your own
- Multiple provider data repositories
- Inaccurate provider directories are creating member dissatisfaction
- Inconsistent and erroneous provider data across health plan departments and systems
- Provider data difficulties can hurt a health plans’ CMS Star Ratings
A. The Golden Data Record is the data sitting in the Single Source of Truth that is most current and accurate. This Golden Data Record may be the result of algorithms that fuse multiple internal and external data sources. SmartEnroll™ enables you to support individual or mass enrollments, benefiting from a pre-population of data from your external reference data sources to minimize data entry and the risk of typing errors. IntelliMatch™ enables you to continue to match new data that comes into your system via internal and external sources to the correct provider record, so that the Golden Data Record reflects the single, disambiguated, and most current data representation of a provider.
A. By automating the Provider lifecycle process, Health Plans can:
- Load provider data and contracts once and integrate this information across the enterprise.
- Eliminate the data conflicts between multiple repositories.
- Manage operations with how you chose to run your business, not how inflexible software may be designed.
- Maintain data accuracy and resolve conflicts with our IntelliMatch™ capability
- Improve the speed, efficiency, compliance, and cost-effectiveness of provider data and contracts.
- Keep provider directories current improving member experience.
- Improve CMS Star Ratings
What our customers say.
DIRECTOR, PROVIDER CONFIGURATION
We are excited to see a solution like eProviderSync™ in the market. It will help us streamline our legacy manual processes and improve accuracy and speed to market significantly.
FORMER LARGE HEALTH PLAN PROVIDER EXECUTIVE
In my opinion, eProviderSync™ is the only end to end solution that can help solve the Provider data and contracting challenge in the industry at the root cause. It creates a robust, configurable single source of truth and has a intelligent algorithm to the keep the data updated.