Provider

Provider Claims Integrity & NPI Solutions

Delayed claims submission and denied claims due to inaccurate provider data are two of the largest issues facing today’s hospital billing professionals. Getting a claim paid in a timely manner can be a complicated process, especially when incomplete information is submitted by a referring provider. And with the implementation of the national provider identifier (NPI), the possibility exists of significant disruption to the claims process for providers. The importance of ensuring claims will not be denied is critical to accelerating the hospital revenue cycle and effectively managing cash flow.

Heath Market Science has developed solutions to help at multiple stages of the hospital revenue cycle. First, we can create and maintain accurate provider databases to ensure all participating physicians’ information is correct in legacy systems. Second, we assist hospitals, IDNs, large groups, and PPOs to enumerate their employed providers in the NPPES in bulk. Third, we give billing professionals online access to the discovered universe of domestic healthcare providers to speed billing. These solutions from Health Market Science enable hospitals and IDNs to quickly realize improved financial performance, cash flow, and profitability by submitting accurate and timely claims.

Many factors contribute to incomplete and inaccurate provider data. With over 5% of provider data changing every month due to address changes alone, keeping track of the four million unique healthcare providers is a complex challenge. Identity errors and incomplete records make it difficult to accurately match a provider claim with the appropriate contracted plan. This challenge is further magnified as providers typically have affiliations to hospitals, long-term care facilities, and group practices. This many-to-many network emphasizes the need for a continuously updated verified source of external provider data.

Learn how Health Market Science provider solutions are:

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