Developing 95-percent Accurate Provider Networks
With mounting administrative costs, compliance mandates and increases in fraudulent activities, efficient provider data solutions are critical to Service Providers. TruthMD understands the needs of Service Providers from their search for ways to increase Payer client operational and claims efficiencies to the continual need to improve trading-partner experiences for their end clients.
For years, doctors have provided up to 90% of the information used in healthcare provider directories. Doctors also were responsible for self-reporting much of the information service providers use for provider eligibility, network development, contracting and operations.
Before TruthMD, there was little Service Providers could do to verify demographics. Today, MedFax data solutions enable Service Providers to review complete and integrated physician profiles, and close provider verification loopholes without dedicating staff members to weeks or months of expensive, labor-intensive manual research.
With MedFax data solutions, Service Providers have access to a complete, validated physician demographic profile and practice history for their current or prospective providers while being able to constantly monitor primary data sources for:
The most valuable resource of fraud, waste and abuse programs can be summed up in a single word: time. TruthMD’s MedFax helps by expanding and accelerating provider-centric Fraud awareness.
Service providers know what a significant impact an ineligible provider can have on their networks. The longer that ineligible provider remains in their network, the more dollars they will be paid, and those dollars will likely be unrecoverable. Additionally, the more time it takes to identify a fraud, waste or abuse issue, the less likely service providers are able to stop claims being paid to sanctioned, fraudulent or excluded providers. With MedFax solution, ineligible claims from fraudulent providers are identified and pulled from the payment stream, eliminating all risk of recovery.
TruthMD’s MedFax provider data solutions enable Service Providers to regain that invaluable resource: time.
MedFax data solutions are designed to meet the needs of service providers and payers. Access to accurate and real-time data is crucial to operational efficiency while government compliance increasingly focuses provider directory accuracy, adequacy and ongoing sanctions monitoring.
Foundational provider demographic information advancing directory-digital experience and improving overall claims adjudication.
Real-time provider license and exclusion records delivered “At Time” for mandated sanction monitoring, primary source verification and network management, with data historically unified under a single NPI.
Applying the MedFax distinctive dataset with proprietary algorithms to identify fraudulent claims pre-payment, identifying potential Provider issues, creating a bad actor lead generator for a health plan’s SIU.