Payers and Health Plans
Data inaccuracies substantially raise the cost of doing business because they result in increased manual labor, mailing misdirections, fiscal penalties and inaccurate payments to providers.
Health plans must be vigilant that a patient’s protected health information is safeguarded from inappropriate access by providers with questionable credentials.
In addition to compliance, accurate provider information is critical for optimizing core business processes at health plans, including:
- Provider file maintenance
- Auto-adjudication
- Credentialing
- Network development
- Provider contracting
- Fraud and abuse investigations
- 1099 reporting to the IRS
HMS provider data products and services give health plans information that is needed to reduce administrative costs in order to comply with mandated medical loss ratio regulations.
