Next Generation Provider Lifecycle Management

Automate provider data and contract lifecycle management for Payers
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Simplify Healthcare is positioned in the Leaders Category in the 2023 IDC MarketScape for U.S. health plan product/plan benefit configuration solutions.

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The Provider1™ Advantage

Streamline provider data and contracting processes, ensure accurate data is loaded into downstream systems, and improve provider relations

Enable Intelligent Provider Master Record

Configurable data structure with business rules and best practice in workflow and provider hierarchy

Fees and Rates

  • Capture detailed fees & rates to integrate with Core-Admin
  • Supports Fee For Service or Value-Based structures
  • Detailed to DRG code or ICD9/10 level of detail

Credential Provider

Integrate with CVO or conduct in-house credentialing

Contract with Providers

AI-enabled negotiation of contracts, fees, rates, and reimbursement models including VBR. Validate and generate contract artifacts and e-Sign finalized contracts

Provider Self-Service

Transparency through onboarding with ongoing updates and self-service

Benefit Network Affiliation

  • Associate networks to providers
  • Easily cascade network info to practitioners associated at an Organization or Location level

Data Quality

Automated data migration from legacy system to Provider1™ with data cleansing. Ongoing data quality maintenance via IntelliMatch™. Automated roster file uploads

Rapid Data Migration

Migrate disparate sources into a robust single source of truth

Integrations

  • Core-Admin integration and reimbursements
  • High quality provider data, powering your provider directory

Insights

Provider analytics and reporting

Provider1™

Provider1™ platform for Provider Data and Contracts Management

Provider1™ creates a reliable and portable Payer-specific master record and allows Payers to work with data structures and hierarchies that fit their needs

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Provider1™ manages contracts and keeps key contract attributes (i.e., fees and rates) aligned with the provider data

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Connected Provider Journey

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Provider1™ is a part of Simplify Health Cloud™

Power your connected provider data journeys

Enterprise Scale

A trusted partner for Payers, Simplify Health Cloud™ has streamlined and scaled operations delivering outsized outcomes

Simplify Healthcare is positioned in the Leaders Category in the 2023 IDC MarketScape for U.S. health plan product/plan benefit configuration solutions.

What Our Customers Say

Director

Provider Configuration

We are excited to see a solution like Provider1™ in the market. It will help us streamline our legacy manual processes and improve accuracy and speed to market significantly
Senior Director

Provider Services

Provider1™ has delivered significant efficiency improvements for onboarding and managing providers, and the users love it! Did I mention that the Simplify Healthcare team has been a delight to work with?
Director

Network Management

We are so happy with our decision to select Provider1™. We got the solution implemented in six months and it’s made our lives so much better. We have automated how we manage data and contracts for nearly every provider in the state

Frequently Asked Questions (FAQs)

Here is what our customers usually ask us

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

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

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

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

  • 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