Provider Registries Reduce Manual Claims and Enhance Service

Reduce Manual Claims Remediation with a Provider Registry

“Life was easier 10 years ago.” That’s something we’ve heard more than once from payers. Providers back then were fairly static and easy to manage. Today, payers are constantly taking on new providers and covering new services—and many of these new providers are not as rigorous in their claims submissions. The challenges are not simple ones:

  • How do I get one single trusted view of all my providers across all my organizations and systems?
  • How do I avoid creating duplicate providers?
  • How do I know the relationship of my providers to organizations and clients?
  • How do I reduce the ever-increasing number of manual exceptions?

To solve these problems, we worked with multiple payers to create a single source of truth in a provider registry using the IBM InfoSphere MDM platform.

The provider registry uses sophisticated probabilistic matching algorithms to improve the matching of provider information on claims to the provider file. In most cases, this has significantly decreased the number of manually excepted claims to be dealt with daily.

In addition, a provider registry streamlines the provider registration process and provides a robust tool for data stewards to manage the provider file.

Improve Services with a 360-Degree View

The number of new clients registered every day is increasing—they’re being added to existing plans, created in new plans or merged from acquisitions.

  • How do I get one single trusted view of all my clients are across all my plans and systems?
  • How do I avoid creating duplicate clients?
  • How do I see household beneficiaries?
  • How do know the relationships between my providers and their clients?
  • How do I manage risk and ensure compliance to all the new regulations?

As a Premier IBM Business Partner, IMT uses the IBM InfoSphere Master Data Management platform to create solutions for payers. All systems and users can see a complete 360-degree view of each client and provider and easily see all relationships that exist. This allows you to provide better service