Provider Data Management

A better way to capture provider information


Provider Data Management (PDM) offers an easy-to-use way for your providers to update, validate, and attest to the accuracy of their information. Why is it easy? Because they can do all these things on the same portal they use to check patients’ eligibility, submit claims, and receive ERAs.

Providers receive regular notifications right in their workflows reminding them of deadlines to verify their directory information. Machine learning and artificial intelligence identify providers whose information is likely to be incorrect or out-of-date; when there’s a mismatch between information the provider is submitting and what the health plan has on file, PDM sends a notification prompting the provider to update the record. This information can then be sent to each of the provider’s contracted health plans, ensuring every stakeholder has the most current information.

Availity Provider Data Management Set Apart

What sets Availity PDM apart

  • Multi-payer platform allows providers to make updates once and have that information sent to all participating health plans.
  • Availity intelligent gateway monitors billions of healthcare transactions to identify data anomalies between what the provider submits and what the health plan has on file.
  • Provider data updates are sent to each participating health plan in the format and structure that health plan needs.
  • Provider education gives providers information about patient quality and risk adjustment processes.

Additional reading

  • Blog - 5 Reasons Accurate Directory Information Helps Providers - Health plans are increasingly under pressure to maintain accurate provider directories, or they risk regulatory fines and potential third-party lawsuits. Given these regulatory and market pressures, healthcare providers are likely to see a lot more requests for up-to-date demographic data from your partner health plans.
  • Featured Article - Mending the Payer-Provider Relationship - Establishing a transparent and collaborative relationship between payers and providers will ease costly and inefficient burdens for both stakeholders and foster the rich, actionable information needed to ensure that value is achieved throughout the continuum of care.
  • Health Plan Week - Streamlining Provider Data Management Could Save Billions...But Is It Possible? - Collectively, hospitals, doctors and health insurers spend more than $2.1 billion a year on inefficient and redundant tasks aimed at ensuring the accuracy of provider data. This is a problem that has built up over years of reliance on updates at credentialing and contracting time, and solving it will take a concerted effort by all stakeholders in the healthcare system.
  • Infographic - The Costs of Bad Data - Inaccurate provider data affects health plans, providers, and patients - the CMS says it's a significant barrier to care. Here are seven ways errors add to administrative costs.
  • Infographic - Better Provider Data Starts With Better Provider Credentialing - Credentialing a provider is an early step in the provider-health plan relationship. The data that's gathered lays the foundation for all the interactions to come. And yet, 80% of providers say they're unhappy with the complexity and difficulty of the credentialing process. Here's are seven things Availity learned when we surveyed health care staff members who handle credentialing for their practices and facilities.
  • Infographic - What's Inside the 2018 CMS Report on Provider Directories? - In January 2018, the CMS released the results of their second audit of provider directories, and the numbers aren't good. This infographic shows where 54 health plans are struggling to get their provider data under control.
  • Better Provider Data Management Could Save Health Plans Millions Per Year - With an investment of just $500,000, a leading regional health plan launched Availity's Provider Data Management workflows shortly after the CMS provider directory accuracy regulations went into effect. Within the first year, 100% of their network providers had been notified to update their directory information, and a new provider registration app automated 95% of new provider registrations. Their savings in that first year: $1,600,000 - or 300% of investment!
  • Case Study - Reduced Costs, Increased Engagement - Florida Blue invested early in correcting the accuracy of their provider demographic information, and achieved 300% return on their investment in the first year. This article describes how working with Availity helped them orchestrate deeper, more effective provider engagement.
  • Assessing Provider Data Within Your Health Plan - In this article by Availity's senior manager for data management and analytics, we take a look at how people, processes, and technology affect the quality of the data that drives today's healthcare economy.
  • Provider Data Management - Availity's Provider Data Management gives health plans a comprehensive workflow that equips providers to keep their information up to date - and that lays the foundation for effective communications and collaboration between plans and providers.
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