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Provider Directory Advantage

Relentlessly updated and validated information for provider directories, claims processing, provider communications, and quality of care clinical processes

Health insurers require accurate, validated data for smooth operations and rapid reimbursements and revenue recognition. The affordable, easy-to-use Provider Directory Advantage service gives health plans the timely, accurate provider directory data they need, easily integrated with payer systems and provider databases.

5 Essential Provider Directory Components

Provider directories are notoriously inaccurate. Even worse, CMS accuracy standards carry a penalty of up to $25,000 per Medicare Advantage beneficiary for audit failures. Provider Directory Advantage directly addresses these and other critical needs, including:

Provider Database/Directory Augmentation – Automatically sourced public, private, and proprietary resources to update provider databases at frequent intervals. Advanced algorithms regularly assess these records to identify changes and anomalies, and HealthLink Dimensions staff validates records to ensure accuracy. This data integrates seamlessly with payer systems while augmenting them with demographic information and advanced segmentation tools.

Provider File Credentialing and Maintenance – Automated and manual sourcing and validation to accelerate credentialing onboarding and updates. Provider Directory Advantage also alerts for events, sanctions, and status changes.

In-Network/Out-of-Network Claims Validation – Nationwide lists of OON medical and dental providers to accelerate adjudication. Provides on-demand lookup and connects with other HealthLink Dimensions services for price negotiation and Letters of Agreement (LOA).

Provider Communications – Health plans need to know how to reach providers using the method and time of day most likely to generate a response. Provider Directory Advantage syncs with other HealthLink Dimensions for detailed, accurate information, as well as powerful but easy-to-use segmentation and marketing outreach tools.

Quality of Care Information in Network Sculpting – Quality of care insights are essential to control costs through network narrowing and guided member services navigation. Provider Directory Advantage enhances directory data with CMS Hospital Compare and Physician Compare metrics.

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