Many health plans rely on legacy systems where provider data is stored in multiple, disconnected data repositories. Core xRM’s Provider Data Manager (PDM) offers a health plan the option to manage all provider data in a consolidated source of truth thereby eliminating the need to cross-reference multiple systems for operational functions such as contracting, online provider directories, and reimbursement.
The Core xRM PDM solution is built on Microsoft Dynamics CRM, a flexible and customizable enterprise relational data management system that can evolve as business processes and care delivery models change over time.
The Core xRM PDM was developed to accommodate the needs for compliant provider directories, contracting, and provider reimbursement. The PDM solution organizes and maintains more than 175 data points, including:
Health plans will greatly benefit from the automation and workflow capabilities built into the Core xRM PDM solution. Rosters from any entity a plan contracts with can be uploaded to the system and then analyzed for changes, such as detecting providers that have left the network, moved to a new servicing location, has changed a remittance address, and more. Flexible business rules will ensure that incomplete records are flagged and prevented from entering the source of truth.
A roster with more than 5,000 providers rendering services in 12,000 locations can be analyzed for changes within 20 seconds. The resulting changes can then be applied to source of truth and made available for distribution to the plan’s various administrative and operational systems.
DATA EXCHANGE CAPABILITIES
Once implemented, the provider source of truth can be used to distribute provider data to the plan’s operational/administrative systems and/or third parties. The Core xRM PDM offers integration capabilities, including:
The Core xRM Provider Data Management (PDM) Solution can be customized or adapted to meet your specific business objectives.
Contact us today to learn more.