Provider Data Management | symplr Payer

Expedite credentialing processes and protect your members

Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution.

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Trusted by leading payer organizations to achieve superior results

“Thanks to symplr Payer, we can credential 60% more providers (5,000 up from 3,000) 30% more quickly with the same staff because symplr Payer automates the primary source verification. It pulls, uploads, and stores the supporting verification for us. Everything we need is right there!”

Grow your networks, fortify compliance, and drive revenue

Provider credentialing is a highly regulated, time-consuming, and laborious process, often taking three to six months to complete. With 2-3% of provider demographic data changing monthly, payer organizations struggle to maintain high-quality provider data, let alone fix inaccuracies.

The risks associated with poor provider data integrity go far beyond inefficiency and increased timelines. Payer organizations face greater risk in data security; and incomplete or inaccurate information regarding a provider’s professional certifications, work history, or malpractice insurance can lead to extensive credentialing and enrollment delays, causing member access issues and lost revenue.

To keep up with the growing volume of applications, payers need to be able to improve efficiency and scale their operations. Tools such as batch processing, web crawlers, and form-automation technology can improve critical workflows for primary source verification, credentialing, and enrollment.

symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems.

Streamline contracting to get members access to high quality, cost-effective care

Seamlessly negotiate, generate, and manage contracts for all provider types

Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more.

Create a single source of truth for provider data

symplr Payer’s unique design allows your organization to consolidate contracting, credentialing, and provider information management activities into a “single source of truth” system. All aspects of provider data can be maintained to provide a consolidated online data repository for reporting, directory generation, and network development.

Credential providers up to 60% faster

The system supports automated primary source verification including interfaces with NPDB’s Querying via QRXS, Continuous Query Service, SAM, OIG, ABMS, DEA, NPPES, CMS Opt Out and CMS Preclusion, as well as instant targeted verification for state licensing sites.

Manage every aspect of provider information

Enable self-service applications using eApply

Take data-chasing off your plate and enable self-service for applicants with eApply in symplr Payer, which provides practitioners with an online application. Once the provider has entered their data, any additions, changes, and attached images will be uploaded to symplr Payer. The data can automatically load or be reviewed and accepted by internal staff and then merged into the live database.

Efficiently manage your network

With dedicated tables and tools, your organization can streamline the management of your network. Accurately track provider location, specialty, network status and other details with the ability to query, report and sort all provider data to meet regulatory and market standards.

Import multiple data sources with Dynamic Import Utility

Dynamic Import Utility enables symplr Payer to be a broker of all provider management data. You’ll be able to reduce manual entry by importing data from unlimited data sources including CAQH, key industry sources, and client-specific sources such as delegate entities and CVO verified data.

Share data updates with internal stakeholders using eSearch

Provide internal staff the ability to look up practitioner and credentialing information in a view-only mode. Designate specific images to be available to the end-user to preview and/or download. eSearch is ideal for internal users who do not have a license to the symplr Payer core application and do not need to make data changes.

Track and measure quality performance data with symplr Surveys

Create, score, and report on data gathered for medical charts and site reviews, practitioner quality and performance tracking, and patient satisfaction measures. We also enable you to track and analyze key indicators to comply with NCQA, CMS, and URAC standards, as well as organizational targets and indicators.

Protect your data using a HITRUST-certified solution

Work with confidence knowing your data is protected with the highest level of security. With HITRUST CSF certification, symplr Payer is compliant with applicable state, federal, and international regulations. symplr Payer is the only provider data management SaaS solution to achieve this level of security.

See how symplr Payer can streamline your credentialing process

Talk to one of our experienced team members today to get a demo and learn how symplr Payer can help your payer organization.

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See how symplr Payer has boosted provider satisfaction and retention

symplr Payer's seamless, virtually effortless report creation using real-time data provides the transparency we need to take action and make decisions.

NILS LINDAHL

Provider Data Steward, Hennepin Health, Minneapolis Minnesota

symplr Payer auto-populates and cascades the updates across the entire system, which ensures accuracy and timeliness, and reduces the possibility of human error.

NILS LINDAHL

Provider Data Steward, Hennepin Health, Minneapolis Minnesota

Resources

Blog

symplr Roundtable Explores Health Plan Challenges with No Surprises Act

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Analyst Report

symplr Recognized as a Major Player in IDC MarketScape Report on Provider Data Management for Payers

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Blog

What Does the No Surprises Act Mean for Payer Organizations?

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