It is Friday afternoon, and all you can think about is getting out on the green tomorrow at the top-notch golf course everyone talks about. The only problem is scoring a coveted Saturday tee time takes serious planning skills. If you have not booked it already, forget about it. You might as well plan to hit a bucket of balls instead.
The same concept applies to provider data management. Similar to reserving a tee time, you must plan to succeed. Establishing your processes, protocols, and procedures can ensure a more efficient and compliant data management strategy. Consider these steps as you formulate your provider data management strategy.
Evaluate The Status of Your Data
Before planning what to do, assessing where you are now is essential. Evaluate the provider data you have in your system, how it is being used and the quality of the data. This information will help you identify any gaps in your data and determine how you will address them.
- Do you have coverage gaps?
- How many of your providers are ghost providers?
- Do you have providers in your data missing information?
- How many providers have a high number of locations?
Once you’ve identified the areas needing improvement, you know where to start and can tackle them head-on.
Did you know? A complimentary provider data assessment by Quest Analytics will help you see what’s right, wrong and missing in your provider data.
Identify Your Current Processes and People
You know areas for improvement with your data. It’s time to learn who and what does what. Talk to the people and teams responsible for your provider networks and ask questions like:
- What tools do we use to identify provider updates? Are they working well?
- What is our process for removing providers from our database?
- When is the IT team involved?
- How do we find providers to add to our network?
- Who submits our network for a network review?
- Who updates the online provider directory and the printed directory?
By having a more thorough understanding of the teams and tools, you pave the way for organizational alignment and efficiency. Not only will this allow your team to pinpoint any existing workflow gaps, but it will also provide valuable insights for optimizing and enhancing the process.
Pro Tip: If you partner with another plan, determine who’s responsible for keeping the provider data updated and who’s on the hook if the network fails to meet compliance requirements. By clearly agreeing on responsibilities beforehand, you will save time and energy.
Document Your Provider Data Management Process
Now that you’ve established the state of your data and know how you handle any changes, it’s finally time to document your updated provider data management process. Think of documentation as the bedrock of your entire strategy, ensuring everyone involved knows their roles and responsibilities. It minimizes confusion, cuts down on redundant tasks and saves you from backtracking. On top of that, it helps ensure you stay compliant.
Pro Tip: Use our handy worksheets to help with this process. They’re designed to help you address the right questions and get immediate results.
- Download the Medicare Advantage Worksheet
- Download the No Surprises Act Worksheet
When you document your provider data management process, you make life easier for everyone. Every stakeholder knows exactly what’s expected of them, and they can confidently put processes in place to make it happen. Just like reserving a spot on the golf course days before the big round, having this information is crucial to a successful outcome.
More Provider Data Management Tips & Resources
Proven Solutions for Your Provider Network Management
Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid and Commercial. Schedule a strategy session today and see how we can help you every step of the way.
