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Through Member collaboration, MCRA helps drive performance improvements, deliver exceptional service, transform care, and champion the health and wellbeing of the communities we collectively serve.

Leap Orbit Presents Case Study: How A Regional Payer Improved Provider Data Accuracy By Over 30%

Read the original case study by MCRA Member, Leap Orbit

Provider data accuracy and ghost providers have long been a challenge in the healthcare industry, often compounding the difficulties patients and professionals face by obscuring reliable access to necessary care.


On average, data in provider directory entries have over 50% inaccuracy rate, with reports as high as 81% in five of the largest plans. This creates what is commonly known as ghost networks. See how one of Leap Orbit's clients was able to eliminate ghost providers from their network and improve accuracy by over 30%.


About the Client

Industry: Health Insurance

Size: Over 1 million members

Plans Offered: HMO, PPO, POS, Medicare and Medicaid

Goal: To promote community health and well-being by ensuring comprehensive coverage and provider data accuracy.


Challenge:

Leap Orbit's client encountered a significant challenge in maintaining the integrity of their provider data. With attestation results from their previous vendor falling short, the accuracy and coverage rate hovered around 40%. This compromised the reliability of their healthcare network, affecting member satisfaction and regulatory compliance.


Solution:

The payer partnered with Convergent to enhance their provider data management. Utilizing Convergent’s advanced automation technology and call center capabilities, the team embarked on a data cleansing and enrichment initiative. This process involved rigorous verification of provider details and updating records to reflect accurate, active locations, focusing on high-risk providers for targeted outreach.


Results:

Leap Orbit's collaboration with Convergent yielded substantial improvements for provider data accuracy:


  • Improved Data Integrity: Accurate provider locations were identified and corrected, especially for those previously marked as inactive.

  • Enhanced Network Accuracy: The accuracy of network data improved by over 30%.

  • Seamless Data Integration: Auto-cleansed data was integrated efficiently, making updated information readily available across the client’s systems for member access.


Conclusion

This partnership significantly enhanced provider data accuracy and the reliability of our client’s healthcare network, impacting over a million members. The initiative highlights how innovative data management solutions can address complex challenges and contribute to better community health outcomes.

 
If you're interested in learning more about Leap Orbit, or would like to review the full case study, click here.

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