Improving data quality to decrease provider administration costs

The challenge

A leading Health Plan was responsible for managing data for a network of over 34,000 physicians and healthcare professionals, 160 network hospitals, as well as a nationwide network of non-participating Providers. All Provider data was stored and maintained on a legacy platform. The existing system solution lacked scalability and involved duplication of information.

Our approach

The Health Plan hoped to reduce administrative costs and determined that it also needed a system that could accommodate multiple lines of business, execute robust data integrity checks, provide both standard and ad hoc reporting capabilities, and interface with credentialing, contracting and claims payment systems. Vynamic led the requirements definition for the physician, healthcare professional, and facility business areas. In addition, Vynamic evaluated functional specifications to make sure that they met business requirements, and developed a disciplined testing methodology to validate that business rules were being executed correctly.

The results

The Vynamic team was an integral part in the implementation of our Health Plan customer’s provider data management system. The system automated the provider management workflow process and significantly improve data quality and process efficiency.

Some specific results achieved include:

• Consistent application of business rules across an integrated platform
• Efficient interfacing and exchange of electronic provider data with other systems
• Increased auto-adjudication and claims accuracy by the way of elimination of redundant data entry and manual handoffs