MCRA Member Alliance Brief
Anyone that has spent any time in healthcare knows many Health Plans struggle with accurate, complete, current and duplicated Provider data. The problem becomes very evident when using analytics tools to perform important functions such as top ranking, trending and root cause analysis. It can also greatly impact the value of departmental applications such as Complaints, Appeals and Grievances (CAG).
Leap Orbit’s Convergent data-as-a-service closes the gap on fragmented, poor quality provider data using proprietary matching and cleansing algorithms that unify provider data from large public and proprietary data sets. Their service provides a single source of the truth for Provider data.
Inspire Innovations provides a Complaints, Appeals and Grievances (CAG) software-as-a-servicesolution with a complaint centric analytics module. If poor Provider data flows down into Inspire’s analytic system, it makes accurate Provider centric root cause analysis difficult for their clients. Through their mutual participation in the Managed Care Resource Alliance, Inspire worked with Leap Orbit to engineer a seamless solution.
Inspire’s CAG solution uses NPIs provided by their Health Plan clients to look-up Provider data in Convergent’s data-as-a-service solution. The data from Convergent ensures that the Provider data is consistent and accurate as well as enriches the plan’s data by adding hospital affiliations, sanctions and more.
Inspire’s clients can now more confidently and accurately assess which Providers correlate to top ranking Provider Claim Appeals, Payment disputes and Grievances allowing them to drive Provider education programs or reassess internal processes that minimize Provider abrasion. In addition, augmenting the data can yield practical management actions. Knowing a non-Contracting Provider’s Hospital affiliations for example, can allow a Plan to more easily reach those Providers through those affiliations.