Meet the increasing provider data regulatory requirements

Ensure provider data accuracy, compliance with the 'No Surprises Act', and higher Star ratings with eProviderSync™.

Industry Challenge

  • Reliance on multiple disconnected systems
  • Manual processes for provider contracting, onboarding, and enrollment

Impact

  • High operational costs
  • Bottlenecks and delay

Our Solution

  • Accelerates individual and mass enrollment and onboarding by pre-populating data from external sources
  • Auto-generates compliance-ready documents
  • Digitizes provider enrollment experience through SmartEnroll™
  • Minimizes data entry
  • Automates contracts by up to 90%
  • Reducing typing error risk

Industry Challenge

  • Dependency on noninteroperable disparate systems provider data management, contracting, and enrollment applications
  • Use of legacy systems to populate provider directories

Impact

  • Provider data inaccuracies
  • Non-compliance with the No Surprises Act

Our Solution

  • Supports bi-directional file formats for provider data and directory and data integration through API, batch, and ETL
  • Connects disparate provider data applications
  • Creates a reliable and portable payer-specific master record
  • Enables the management of complex provider data accurately in a logical manner with IntelliMatch™
  • Ensures compliance with the ‘No Surprises Act’

Industry Challenge

  • Duplicate data entry across systems
  • No real-time flow of data across systems

Impact

  • Inaccurate and inconsistent provider data across
  • Negative impact on provider and member support services and calls
  • Increased customer frustration
  • Risk of non-compliance

Our Solution

  • Simplifies and consolidates provider data management functions
  • Delivers a delightful service experience to providers and members
  • Ensures compliance with the CMS and the ‘No Surprises Act’
  • Improves Star ratings

Industry Challenge

  • Missing an overarching master provider management application
  • Lack of integration between provider data management processes

Impact

  • Provider data inaccuracies
  • Inconsistent data across functions

Our Solution

  • Consolidates data management, user workflows, contracting, network and pricing, claims, directories, enrollment, communications, and credentialing functions
  • Automates user workflows and processes
  • Eliminates data and team silos
  • Supports and consolidates all provider functions

Industry Challenge

  • Multiple manual steps to answer provider data and contract inquiries
  • Dependency on multiple data sources

Impact

  • Benefit explanation errors
  • Stretched call handle times
  • Low first call resolution rates

Our Solution

  • Delivers better provider service by giving customer service representatives and self-service portals
  • Real-time access to the correct provider data and contract information

Why eProviderSync ?

Whether it is streamlining provider lifecycle management, contract generation process, or enabling new operating models, we are helping Payers, TPAs, and ASOs transform and improve provider and member satisfaction with just a few clicks.
Data Accuracy
70%
Contracting Automation
90%
Directory Accuracy
75%
Data Reusability
95%
Claims Recoveries
70%
Maintenance Timeframes
60%
Industry-leading solution to solve provider data management challenges

Choose an end-to-end solution or select modules to solve specific pain points

Our provider data, directory, and contracts management solution can be molded according to your business. Select from our integrated modules that suit your business to address pain points and maximize investments.

Integration of other solutions in eProviderSync™ ecosystem

eClaimsEngine™ – Our claims configuration solution, integrates as a component of eProviderSync™ to configure your provider records at one place with intelligent decision support, eliminate repetitive data entry into Core-Admin and other systems, keep your claims system up to date, and automate the maintenance of your provider configuration.

Listen to Our Customers

''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.''
— Director, Provider Configuration
''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 an intelligent algorithm to keep the data updated.''
— Former Large Health Plan Provider Executive
''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.''
— Payer Executive, Network Management

Frequently Asked Questions (FAQs)

Here are the answers to the most frequently asked questions about implementing end-to-end benefit plan management solution and partnering with Simplify Healthcare.

1. What is provider lifecycle management?

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 payment reconciliation. The process of managing the end-to-end provider lifecycle is known as provider lifecycle management. For the Payers, TPAs, and ASOs who have made investments in provider data repositories and need to preserve those investments, the provider lifecycle management solution can flexibly work with existing repositories as a wrapper, enabling its functionality without replacing the current investment.

2. How can you automate the provider data lifecycle management?

eProviderSync™ is an integrated enterprise solution to automate the end-to-end provider data management lifecycle and maintain data accuracy. It helps configure provider data to comply with guardrails for regulations and business policies via centralized business rules. With eProviderSync™, you can collaborate with all the stakeholders to manage provider data, achieve administrative savings, reduce provider service calls, improve call handle time, and reduce claim rework with robust workflow capability, routing, notifications, and a logging function to track all changes.

3. Why use a provider data lifecycle management solution?

Provider data is conceptually straightforward, but it is complex to standardize, manage and maintain. Health plans find managing data for thousands of providers across thousands of contract and network permutations while being responsive to state and federal requirements constantly challenging.

 

Key industry issues that the payers and TPAs face due to provider data management inaccuracies:

  • Increased health plan outreach to providers to gather and validate the information.
  • Providers and consumers being unable to locate specialists or other providers affecting their experience with the payer or TPA and impacting the payer’s Star ratings.
  • Claims with missing or inaccurate provider data cause payment processing failures or denials
  • Impact on members’ abilities to successfully access network providers, leaving health plans vulnerable for the costs of out-of-network care and subject to penalties.
  • Increased calls to provider support hotlines.
  • Concerns regarding compliance with No Surprises Act and Transparency rules.

eProviderSync™ is the only end-to-end solution that can help solve the provider data/directory management and contracting challenge in the industry at the root cause.

4. What are Payer, TPA, and ASO specific master record, SmartEnroll™, and IntelliMatch™?

Payer, TPA, and ASO specific master record is a logical configurable record of complex provider data maintained based on specific context.

 

IntelliMatch™ enables health plans, TPAs, and ASOs to continue to match new data that comes into the system via internal and external sources and correct the provider record with just a few clicks so that the master data record reflects single, disambiguated, and current data.

 

SmartEnroll™ enables Payers, TPAs, and ASOs to digitize the enrollment experience, support individual or mass enrollments, benefit from a pre-population of data from external reference data sources, minimize data entry, and risk typing errors.

5. What can you improve in your provider lifecycle by automating the process with eProviderSync™?

By automating the provider lifecycle process, health plans and TPAs can:

 

  • Load provider data and contracts once and integrate this information across the enterprise.
  • Resolve data conflicts between multiple repositories, maintain data accuracy, and increase data reusability by up to 95%.
  • Achieve administrative savings by reducing provider service calls, improving call handle time, and reducing claim rework.
  • Automate creating a reliable and portable payer/TPA specific master record.
  • Digitize the enrollment experience with SmartEnroll™.
  • Accelerate provider onboarding, enrollment, and seamless contract generation.
  • Improve the speed, efficiency, compliance, and cost-effectiveness of provider data and contracts.
  • Improve the quality and accuracy of provider data and directory for reduced risk of CMS penalties and member complaints.
  • Improve provider satisfaction and CMS Star ratings.

6. Can eProviderSync™ integrate with existing technology infrastructure to solve specific pain points?

eProviderSync™ is an out-of-the-box, modular solution that can be molded to serve any provider function-related challenges. It can serve as an end-to-end solution or seamlessly integrate with the customer’s existing investments to solve specific pain points.

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