WHAT IS A PROVIDER REGISTRY?
The goal of a provider registry is to create a single, trusted list of physicians, practitioners and practices that provide healthcare services. Provider registries are most heavily used in the insurance industry to track eligibility for “in-network” and “out-of-network” providers, but provider registries are useful to a wide array of healthcare organizations. A provider registry lets you understand who the providers are, which patients they have had contact with, and whether or not their credentials are up-to-date.
Mastering “provider data” has been a challenge historically. Provider data differs from patient data in many ways, which creates some unique use cases that must be handled appropriately:
Very little personal data (i.e., Birth Date, Gender, SSN, etc.) is known about providers in many systems.
Provider data may be wildly inconsistent between systems, with many fields remaining unpopulated.
Providers often have multiple addresses and phone numbers since they may serve more than one community.
Providers may have more than one specialty, which might mean they are accredited with more than one identifier.
Practices are commonly started by family members, so there may be more than one doctor with the same name.
National Provider IDs (NPIs) might not be present, or may be affiliated with a practice instead of the individual practitioners.
At IMT, our certified IBM InfoSphere MDM specialists have the experience and best practices to successfully help your organization set up and maintain an effective provider registry. Our team knows the “gotchas” and the ways to make your provider data work for you.