Simplify Qualified Health Plan benefit requirements

Simplify Provider Data and Directory Management

eProviderSync™ is a rules-based, configurable SaaS solution that solves payers’ provider data management accuracy problems through confirmation, consumption and syncing of provider information across applications. eProviderSync™ is an end-to-end provider data management solution that enables the healthcare payers and TPAs/ASOs to solve specific pain points at an application level.

  • Automate the creation of an accurate master record to manage complex provider data in a logical manner with IntelliMatch™.
  • Digitize the provider onboarding and enrollment experience and seamless contract generation with SmartEnroll™.
  • Reduce the risk of penalties and member complaints, improve provider satisfaction, and CMS star ratings hassle-free.

eProviderSync™, a leading-edge provider data, directory, and contract management solution, helps consolidate provider data and contracts.

Enabling healthcare payers and TPAs/ASOs with the emerging business rule-driven solution to automate the end-to-end provider lifecycle administration and improve provider data quality and accuracy by up to 75% and maintenance timeframes by up to 70%.

Business rule-based data ingestion and creation of master record

Ingests data based on business rules and connects disparate provider data applications and creates a reliable and portable payer specific master record for managing contractual data.

User workflow and process automation

eProviderSync™ automates user workflows and processes to create an integrated work environment. It automates contracts by up to 90%, and auto-generates compliance-ready documents.

Compliant, bi-directional, supports multiple file formats

eProviderSync™ is compliant with CMS standards for Medicare and Medicaid provider data and directory and current API and EDI standards like FHIR and X-12. It comes with the ability to push, pull, sync in batch files in real-time.

Supports all provider functions

eProviderSync™ supports all provider functions including data management, user workflows, contracting, network and pricing, claims, directories, enrollment, communications, and credentialling.

Why eProviderSync™?

Whether it is streamlining provider lifecycle management or contract generation process or enabling new operating models, we’re helping payers and TPAs transform and improve provider satisfaction with just a few clicks.
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Provider Onboarding

Improve quality and timelineness up to 70%

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Provider Contracting

Automate your provider contracts (new and changes) up to 90%

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Provider Directory

Improve quality and accuracy up to 75%

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Data Reusability

Increase data reusability up to 95%

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Claims Recoveries

Decrease claims recoveries up to 70%

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Maintainance

Decrease provider data and contract maintainance timeframes up to 60%

Discover how eProviderSync™ is a one-stop shop for healthcare payers and TPAs to automate end-to-end provider data, directories, and contract management.

Application Modules

Our provider data, directory, and contract management solution can be molded to reflect your business! Scale to new frontiers with our cutting-edge modular integrated solution.
Create single source of truth for your plan data

Take control of your data by managing its configuration and use

Establish your single source for provider information to automate the end-to-end provider data management lifecycle. Load, update, change, annotate, and track changes for contracts, claims, credentialing, pricing, networks, and directory use. Manage reports, communications, workflows between teams using .Source
Auto-generate documents to meet regulations

Automate document generation and version management processes

Dynamically generate all provider contracting and communication documents, including agreements, pricing, and network designations from a single source of provider information. Enable omnichannel re-use of the language and dynamically generate print-ready documents to meet regulations or share your information on web portals or through print with .Docs
Improve claims management accuracy

Simplify configuration of benefit plans and keep your claims system up to date

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 with .Claims
Seamlessly share information across the enterprise

Automate the integration of key benefits data and documents into essential systems

Ensure your single source of provider information is integrated everywhere across the enterprise. Seamlessly integrate with and from your technology ecosystem via RESTful APIs, event-based APIs, data streaming via KAFKA or Event Hub, ETL, batch files using .Integrate

Expose your user-configurable data to standard reporting tools

Ensure your dynamic pristine provider data is integrated with your master data management investments and is available in real-time to your reporting and business intelligence tools using the relational database format and flexibly captures all types of benefit plans (all lines of business and market segments) and non-health product information using .DataMart

Frequently Asked Questions (FAQs)

Here are the most frequently asked questions about implementing end-to-end provider data lifecycle 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 and TPAs 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 specific master record SmartEnroll™ and IntelliMatch™?

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

 

IntelliMatch™ enables health plans and TPAs 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 and TPAs 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.

What our customers say.

''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

Ready to get started with eProviderSync™?

Are you interested in learning more about eProviderSync™? Our team is ready to answer all your questions. Let’s make smarter health ecosystems together! Schedule a 1:1 demo with us today!
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Explore our Contract Lifecycle Management Solution

contract management in healthcare
Provider, Employer Group, and Member Contracts Management