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PROVIDER DATA MANAGEMENT

Creating a single source of truth for provider data.

The Need

A special needs plan (SNP) wanted to create a single source of truth for provider data to both increase data quality and better support downstream operations. Acknowleding the need for integration, interface development, and programmatic redesign, the SNP sought DocMe360's technical and operational expertise to manage its portfolio of provider data management systems.


Approach

DocMe360 deployed its range of health plan services to ensure the SNP had both immediate improvements in provider data quality and a longer term data architecture & infrastructure program. These services included:


PROVIDER DATA MANAGEMENT

  • Completed gap analysis and roadmapping for all aspects of provider data: nominations, credentialing, provider relations, account management, contracts, reporting, claims

  • Conducted provider data cleanup throughout migration to create single source of truth for downstream needs, including care management, claims, pre-enrollment, FHIR server, and directory


TECHNICAL STRATEGY

  • Enhanced technical strategy specific to testing, risk management, and vendor management across portfolio of provider IT initiatives, including: Facets BPaaS implementation, FHIR server integrations, provider directory management, IN/OON provider nominations


CUSTOM PRODUCT & ENGINEERING

  • Provided the architecture solution for data warehouses, data marts, data lakes, ETL. This included all aspects of design, technical specifications, build, and testing


PROGRAM & PRODUCT MANAGEMENT

  • Developed comprehensive project management plan for Provider Data Management Portfolio, including roadmaps, reprioritizaition and resource management


Initial Impact

Early successes include increasing the provider record load to 95% of the SNP’s in network providers, and reducing the overall provider record error count by 97%. 

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