MasterFile Individuals
Complying with medical loss ratio regulations requires that health plans reduce administrative costs.
To do so, a health plan must have the most up to date accurate provider data.
The HMS Provider MasterFile™ contains more than 5 million healthcare practitioners and serves as the cornerstone for Health Market Science’s suite of compliance solutions providing credentialing and demographic information about US healthcare providers. Our health plan clients rely on the HMS MasterFile™ to help optimize core business processes including provider file maintenance, claims auto-adjudication and credentialing.
Our back end and front end solutions help tackle regulatory compliance challenges with rapid verification that a health plan is making decisions and conducting business with trusted provider information.
Reduced latency
Based on our work with the top ten pharmacy chains in the United States, HMS established the Provider Data Consortium (PDC). The PDC, unique to HMS, rapidly highlights areas that require research and provides enhanced evidence of practitioner moves, group practice expansions, and sanctions. These daily updates to the HMS MasterFile give our clients the power of trusted compliance-grade information. (Read more about the PDC.)
- The latest demographic data including address, phone, and fax
- Data that drives compliance
- State License
- DEA
- NPI
- Medicare Participation
- Medicaid Participation
- State Sanction
- OIG Sanction
- Medicaid Exclusion
- More accurate and complete group practice affiliations
- Ability to correct false positives and false negatives via our high through-put resolution processes
- Areas which require research are quickly identified
- Enhanced evidence of practitioner moves, group practice expansions, and the like.
No other data source provides this level of penetration, accuracy and reduced latency.
- More than ten years of experience with a relentless focus on quality driven processes.
- Best practices based on experience and lessons learned
- A dedicated team of domain experts
- Unrivaled matching technology focused on continuous improvement
HMS monitors and makes 30,000 verification calls per month based upon spikes, trends, anomalies that are continuously monitored. Contact us for more information.