1101 Laurel Oak Road
Suite 130
Voorhees, NJ 08043-4322

Toll Free: (877) 466-3366

Local: (856) 431-2250

Provider Data Verification Service

Payer Solutions

Provider Data Verification Service

Inaccurate provider data has plagued the healthcare industry for decades. The provider data problem is universal, and the effects are felt by health plans, TPAs, integrated delivery systems, population health organizations, consumers, and providers. In response to consumer complaints, federal and state agencies have introduced penalties for health plans that don’t comply with recently formed regulatory requirements.

Our Solution

Core xRM delivers a turnkey BPO service that helps your organization remain compliant with state and federal regulations pertaining to periodic updates of provider directory data.

Offering a unique blend of technology, direct outreach, and supplemental data sources that achieve high levels of data accuracy, Core xRM has a proven track record in achieving results.

In a 2017 pilot, Core xRM’s verification service successfully verified and returned corrected provider data for 95% of the provider network within a 30-day period. Findings from the pilot revealed:

  • 42% of practices were no longer accepting patients for at least one provider
  • 31% of practices had at least one provider no longer at that location
  • 21% of providers had a change in provider contact information

Provider Group Engagement Options

Offering provider groups multiple methods for maintaining and updating their data dramatically improves provider engagement.  Whether selecting the online portal, fax, or telephone-based verification options, all three options offer a highly efficient verification experience for the provider group.

Here’s what some of the provider groups had to say:

“This was by far the EASIEST verification I have ever done. Thank you!!!!!”
– Jennifer S., Hilltop Family Physicians

“Easy and to the point.”
– Anna, Asthma & Allergy Associates

“Love using the portal – SO MUCH EASIER!”
– Jennifer B., Southwest Retina Consultants

Solution Features

  • Provider verification onboarding
  • Periodic provider group outreach
  • Multiple options for branding the provider verification experience
  • Full audit history including: recorded phone calls, electronic fax records, outreach attempts & dispositions, and email communications
  • Reporting

How It Works

  1. Core xRM works with your IT and business teams to understand how provider data is stored and utilized across your enterprise systems.
  2. Core xRM collaborates with your teams to craft an end-to-end operational strategy for performing periodic and on-demand provider data updates that comply with state and federal regulations. To minimize organizational disruption, we work with your teams to simplify implementation and extraction of data.
  3. Core xRM verifies, corrects and delivers verified provider data to your organization once it is ready using your preferred method, including:
    • API
    • Flat File
    • Ad-hoc reporting
  4. Verified data is delivered to your online provider directories, and can enhance data in other operational systems, including claims reimbursement and medical management.

Top 5 Benefits

  1. Achieve state and federal regulatory compliance by delegating periodic provider outreach to Core xRM whose Provider Data Verification solution is continuously updated to remain in compliance with changing state and federal regulations.
  2. Achieve high levels of data accuracy and provider engagement by partnering with Core xRM to verify, correct and deliver an easy to use solution.
  3. No upfront capital investment. Ongoing operational expense is based on the size of your contracted provider network.
  4. Minimize interruption to your existing IT systems and operational processes by leveraging Core xRM’s Provider Data Verification solution service and industry expertise.
  5. Improve satisfaction and decrease complaints related to provider data by providing accurate and timely information to members and providers, ensuring the best possible results!