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Integration is occurring in all facets of healthcare, but we’re focused on a topic close to home: Integrating provider credentialing and payer enrollment (PE) functions. Ask practical questions to eliminate redundancies and share information, regardless of what resources you have, and in spite of what seems like an enormous task.
Your mission, should you choose to accept it, is to be a clandestine gatekeeper of patient safety. An enforcer of rules set by states, the federal government, accreditors, and your organization. A detector of danger within data, to secure revenue. You’ll confidentially communicate, negotiate, evaluate—adapting to the environment and priorities. You will be...an MSP. This blog will self-destruct in 5 seconds.
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Amid the rapid changes occurring in all facets of the medical field, it’s hard for busy small and independent practices to keep up. Fortunately, new technologies that make practice management easier and more efficient continue to proliferate, ultimately improving the patient experience.
As intermediaries between payers, pharmacies, and pharmaceutical manufacturers, pharmacy benefits managers (PBMs) can help lower drug prices and slow the growth of drug spending, according to the CMS. Achieving these goals in a competitive and highly regulated space requires PBMs to capitalize on their greatest asset—detailed and up-to-date pharmacy data. But most PBMs don't track the pharmacies and pharmacists in their networks using software designed specifically for provider data management. Here's how a cloud solution for enterprise provider data management gives them an edge.
They pop up in provider background checks, on payer enrollment applications, in practitioner job time frames, and as malpractice claims. They’re red flags. They—and subtler, so-called pink flags—identify data, documents, gaps, discrepancies, or verbal communications that bring into question the validity, accuracy, or existence of an item in a healthcare practitioner’s background.
Payer enrollment or provider enrollment (PE) departments asked to report on key performance indicators (KPIs) for the first time often view it as a daunting task, and many aren't sure where to begin. The good news is, your CVO or PE office can start small yet make a big impact. The data your PE department or function collects in the form of practitioners’ personal and professional information is essential to the business side of medicine. “Provider data” encompasses information about individual providers, groups of providers, facilities, and organizations. While the term seems straightforward, it represents a complex array of information that healthcare organizations collect, standardize, analyze, and maintain in many different ways.