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Provider Data Management (PDM) Solution

Payer Solutions

Core xRM Provider Data Management (PDM) Solution

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.

Our Solution

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:

  • Provider Demographics
  • Participating/Non-Participating status – per network
  • Contracted/Non-Contracted – per network
  • Servicing Locations
  • Billing/Remit Addresses
  • Mailing addresses & contact information
  • Fee schedule assignment
  • Office hours
  • Panel status
  • Accepting new member status
  • Specialties
  • Languages
  • Hospital Affiliations

Automation Capabilities

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.

High Performance

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:

  • Modern web-based APIs
  • Flat file exchanges
  • Messaging-based interfaces

Top 5 Benefits

  1. Consolidate multiple legacy systems, Excel spreadsheets, and Access databases into a single provider source of truth to eliminate data redundancies within the enterprise
  2. Streamline provider data management operations by taking advantage of the rich automation capabilities of the PDM
  3. Improve provider data quality by configuring business rules that detect incomplete or inaccurate records before they pollute the remainder of the enterprise
  4. Integrate PDM with virtually any system
  5. Take advantage of rich reporting capabilities by creating ad-hoc or scheduled reports