Modernizing Provider Network Management With an Integrated Approach

Existing provider network management solutions are often developed for a single purpose, cobbled together with a disjointed combination of homegrown and legacy IT. They have been supporting evolving organizational needs such as credentialing portal, provider data analysis, and more. However, this approach is not a long-term solution to provider network management needs and prevents payers from gaining an unbiased, unified view of provider performance. Relying on claims data alone is insufficient.

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Providers and payers spend billions of dollars maintaining provider databases, and errors in provider directories can cause costly penalties.

In the current payer landscape, provider data is spread across various applications including claims, credentialing, recruitment, and engagement applications.

Fragmented provider data prohibits payers from viewing network performance, evaluating its adequacy, and gauging the need for new providers


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