Improve Provider relations, revenue optimization, and operational efficiencies by managing Provider data from back office to your digital front door

eProviderSync™ enables efficient and accurate provider data and contracts management across a Payer’s back and middle office functions.
The Collaboration Portal manages the digital front door to Providers so they can self-serve critical functions, access real-time updates, and collaborate with their Payer counterparts to streamline processes between organizations.

Leverage Provider1™ to enable collaborative Provider relationships governing contracts, data, reimbursements, and more

Industry Leading Provider Data Management (PDM) Capabilities

Comprehensive End-to-End Provider Data and Contract Management

Manage onboarding and enrollment, contracting, (re)credentialing, data repository, pricing, maintenance, and integrations (directory, claims, etc.).

One-Stop Shop Solution – Modular Approach

Create Provider master records, sync Provider data across operational systems and enable roster and external Provider data management. Manage standard and non-standard contracts and automate end-to-end processes with workflow automation. Leverage user configured business rules to govern system edits and decisioning.

Industry Leading Provider Data Management (PDM) Capabilities

Comprehensive End-to-End Provider Data and Contract Management

Manage onboarding and enrollment, contracting, (re)credentialing, data repository, pricing, maintenance, and integrations (directory, claims, etc.).

One-Stop Shop Solution – Modular Approach

Create Provider master records, sync Provider data across operational systems and enable roster and external Provider data management. Manage standard and non-standard contracts and automate end-to-end processes with workflow automation. Leverage user configured business rules to govern system edits and decisioning.

Superior Provider Experience

Collaboration Portal Brings Providers Into the Workflow

Offering self-serve and information transparency to Providers delivers a game-changing experience.

Automation Eliminates Human Error

Automate Documents and Provider Data File Updates

Eliminate all of the manual steps and the errors that come with them; productivity functions create significant efficiencies.

Provider Self-Service

Providers can directly submit roster files, benefit from data pre-fill with SmartEnroll™, view contract details, and check status of critical information, with no effort from Payer teams.

Automation Eliminates Human Error

Automate Documents and Provider Data File Updates

Eliminate all of the manual steps and the errors that come with them; productivity functions create significant efficiencies.

Provider Self-Service

Providers can directly submit roster files, benefit from data pre-fill with SmartEnroll™, view contract details, and check status of critical information, with no effort from Payer teams.

No Surprises Act Compliance for Directories

Rapid Data Updates

Automated data intake via IntelliMatch™ and data distribution to the Directory.

90-Day Audits

Waterfall audit process every 90 days with integrated results into the repository.

Data Validation at the Source

SmartEnroll™ and Roster File Data Validation

Third-party data sources improve data quality during Provider self-serve processes to help ensure that only correct data is entered into the repository.

Ongoing Data Validation

Ongoing data validation enhances data accuracy, directory quality, and stakeholder experience.

Data Validation at the Source

SmartEnroll™ and Roster File Data Validation

Third-party data sources improve data quality during Provider self-serve processes to help ensure that only correct data is entered into the repository.

Ongoing Data Validation

Ongoing data validation enhances data accuracy, directory quality, and stakeholder experience.

Listen to Our Customers

Frequently Asked Questions (FAQs)

Here are the answers to the most frequently asked questions about implementing end-to-end Provider data and Contract lifecycle management solution and partnering with Simplify Healthcare.

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.

How can you automate the Provider data lifecycle management?

Provider1™ 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 Provider1™, 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.

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

Provider1™ 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.

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.

What can you improve in your Provider lifecycle by automating the process with Provider1™?

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

Can Provider1™ integrate with existing technology infrastructure to solve specific pain points?

Provider1™ 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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