Understanding the Provider Data Management Lifecycle
Understand the limitations of traditional provider data management and what to look for in a modern provider data management solution.
PAYERS & HEALTH PLANS
Tackle health plan and payer data challenges head-on
Gaine Coperor unifies and transforms your data, giving your teams a single source of accurate, consistent, and connected information for all your systems and reports. You'll improve data quality, process claims faster, and gain valuable insights, leading to better member care and operational efficiencies.
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“A data platform serves as a bridging asset between the organization's clinical and administrative components, both of which are essential to full compliance with the operational and technical elements of regulations, the satisfaction of members and providers, and the development of the base for AI."
Jeff Rivkin, IDC Research Director, Payer IT Strategies
From IDC Analyst Brief, “Overcoming Data Chaos: The Imperative for Payers to Adopt a Healthcare Data Management Platform,” June 2024
USE CASES
Accelerate revenue and reduce costs
Accelerate claims reconciliation
Provider data issues, such as outdated contract and network data, often disrupt claims processing, leading to poor auto-adjudication rates and increased administrative burden. Trouble shooting is impaired by lack of visibility into claims processes. With Coperor, you can:
- Track all claim transactions for complete custody chain
- Eliminate duplicate claims before they reach core systems
- Generate real-time reconciliation reports for comprehensive episode-of-care insights
Enhance provider data management
Payers rely on multiple applications for critical functions, such as provider directories, onboarding, credentialing, and others. These systems often operate independently, leading to inaccuracies and inconsistencies. Coperor offers a centralized provider data management platform that addresses this challenge by:
- Integrating provider data from disparate systems, rosters, and formats into a single database
- Mastering and validating provider data with validated identifiers, including NPI, licenses, DEA, board certifications, sanctions, and more
Improve member experience and retention
Eliminate fragmented data and manual processes that lead to inaccurate provider directories, billing errors, and care delays. Coperor provides a 360-degree view of members, providers, payers, and claims, offering:
- Up-to-date, easily maintained provider directories for seamless in-network care access
- Integrated member data for personalized care management
- Streamlined claims processing and timely prior authorizations
Advance HEDIS and Stars performance
HEDIS and Stars Ratings significantly impact financial rewards and regulatory compliance, but many payers struggle with timely and accurate reporting. Coperor HDMP transforms this process with real-time data management, enabling:
- Continuous monitoring and improvement supported by real-time clinical data to feed HEDIS and STARS quality measures
- Automated data collection and reporting, eliminating “chart chasing” and reducing errors
- Personalized care coordination based on comprehensive, up-to-date member data
Elevate employer group reporting
Employer group reporting is becoming increasingly complex and demanding, with health plans facing pressure to manage costs and demonstrate value. Data silos, manual processes, and evolving requirements hinder accurate insights and timely decision-making. Coperor streamlines reporting process with:
- Unified fragmented data from multiple sources into a single, comprehensive platform
- Automated data integration and transformation, reducing manual effort and errors
- Enablement of advanced analytics based on accurate, consistent data
Optimize contract performance and networks
Payers struggle to maintain accurate contract and network data due to complex provider relationships and frequent changes. Effective provider data management prevents compensation errors and enables more insightful network analysis by ensuring specialty, network, and affiliation information is kept current and correct. Coperor offers:
- A unified view of contract data, claims information, utilization patterns, and provider performance metrics in a single platform
- Real-time analysis of contract performance, network adequacy, and utilization patterns across the network
- Data-driven insights for informed negotiations and contract adjustments
“Claims were being lost in our systems and rejected without provider notification. By implementing Coperor HDMP, unpaid claims were reduced from 200,000 to just 17,000 within months, representing over $300 million in unpaid claims."
Chief Administrative and Operations Officer, Top 5 California-based health insurance provider
INTEGRATIONS
All your health data in one place. Connected everywhere.
Synchronize seamlessly with your existing core claims and administration platforms, EHR, data warehouses, provider data management systems, reporting and analytics tools, and other critical healthcare systems. Uncover new context for data that is otherwise wasting away in your data warehouse. No more data silos or manual updates – just real-time, actionable insights that drive better care.
Insights
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