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Payer Solutions Overview

The numbers don’t lie – and they represent a formidable challenge for payer organizations seeking to control costs and improve operating efficiency:

  • 30% of providers change hospital or practice affiliations annually
  • 5% of providers change their license status every year
  • 4% of providers change contact information every month

This constantly changing environment leads to challenges for everything from referrals to OON claims processing to credentialing, sanctions, and communications.

Matters get even more challenging for hospital price transparency:

  • Only 72% of hospitals studied provide DRG, APC, or procedure codes
  • Only 47% list minimum and maximum negotiated rates
  • Only 38% deliver payer-specific rates

Health insurance companies that rely on government sites for provider and transparency information put themselves at an immediate disadvantage. For example, the NPI NPPES database contains many providers whose information has not been updated since 2006. Other public provider records remain updated irregularly, at best.

Payer organizations need an updated, secure, 24/7 resource for providers, hospital pricing, and other essential data needs. More importantly, these services must integrate seamlessly with existing systems without requiring significant investments in infrastructure or staff.

HealthLink Dimensions Payer Solutions

HealthLink Dimensions’ payer solutions combine industry-leading provider data resources and services with payer solutions designed specifically to give health insurance companies the information they need to operate more efficiently and effectively. These easy-to-use, intuitive solutions map directly to payer workflow, including:

Provider 411 for credentialling support and provider contracting, OON claims management, provider communications, and member care coordination

Provider Directory Advantage for timely, accurate provider directory data that supports multiple functions ranging from provider information sourcing and validation to credentialing, claims management, communications, and more

Network Adequacy for automated analysis and documentation to meet CMS Medicare Advantage and state adequacy requirements

Hospital Price Transparency to give payers a simple, one-stop resource that gathers hospital pricing information across the US and puts this data into a single resource for actual apples-to-apples pricing comparisons

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