SKYGEN
The accuracy of provider directories continues to be an ongoing issue in dental care and the wider healthcare industry. Despite state and federal regulations requiring health plans to regularly update directories, and related fines that can start at $1,000 per day per violation, inaccuracies in provider directories continue. And continue. And continue: One 2024 study found that 40% of provider directory inaccuracies last an average of 540 days. That’s 1.5 years.
The Difficulty of Staying Current
The complexity of provider data management has made solving this issue difficult. There are multiple challenges in maintaining accuracy:
- Constant changes in provider data, from a move in location to newly offered services to a change in network participation, make data maintenance time-intensive and prone to errors. A study published by AHIP in 2017 revealed just how much of an administrative burden this has been for payers and providers. The study tested the validation process with more than 150,000 providers through two methods:
By portal: Payers were only able to reach 35% of the practices, and it required an average of seven notifications to get a single validation. Just 18% of providers completed the validation process.
By phone/fax: Payers were only able to reach 39% of the practices. Again, just 18% of providers completed the validation process and it’s no wonder – it took single-location, one-provider practices an average of 16 minutes to complete the 37 questions.
- Legacy systems on the payer side are not up to handling intricate provider data hierarchies involving multiple attributes such as practice locations, affiliations, and billing details. In addition, use of provider data across numerous systems and departments can lead to conflicting versions and operational burden when reconciling third-party data from sources like NPPES and state licensing agencies.
The result of this data sharing and maintenance challenge has been frustration and wasted time for payers, providers, and member-patients. The need for an automated, accurate solution that keeps pace with changing provider data has never been clearer.
Revolutionizing Provider Data Accuracy, Efficiency, and Integration
SKYGEN’s innovative Provider Data Management solution, powered by the Dental Hub, simplifies and modernizes provider data management. By centralizing and automating processes, SKYGEN ensures provider data accuracy, timeliness, and seamless integration across systems.
Key features of SKYGEN’s Provider Data Management solution:
- One-and-done self-service - Providers update information once, on one platform; updates are pushed in real-time to all payers participating in the Dental Hub.
- Seamless data integration - Data flows to payers’ systems (via API) or SKYGEN’s Enterprise System, supporting event-driven updates and real-time distribution.
- Costly outreach eliminated - Automated, digital reminders help providers keep their information on the Dental Hub current.
Because SKYGEN’s Provider Data Management integrates seamlessly with payers’ systems, insurers do not have to be using the SKYGEN’s Enterprise System to get the benefits of this solution.
The SKYGEN Advantage: Best-in-Class Provider Data Organization
SKYGEN’s data structuring methodology is a unique feature that eliminates a core provider data management challenge for many payers: duplication of provider records. SKYGEN organizes provider data using a combination of provider, location, payee, and tax entity records. This prevents redundant records, reduces administrative overhead, and ensures data integrity across systems.
The Future of PDM is Automation
As SKYGEN continues to add payers and providers to the Dental Hub, the power of the Provider Data Management solution continues to increase. Providers on the Dental Hub can put more time into patient care and operations efficiency, with less significantly less effort needed for directory management. Payers have reduced administrative cost and compliance risk. Member-patients have greater confidence in finding accurate, up-to-date provider information, and spend less time searching for the right care options. SKYGEN’s reliable, built-for-dental automation is making the difference.
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