01 / Referrals
Keep referrals inside the network.
Fewer referrals to providers who have left or changed location, and less referral leakage.
Used for
- Member-to-provider assignment
- Network participation
- Referral routing
- Provider directory accuracy
Who we serve › Provider organizations
Referrals leak where patient and provider data meet.
Patient identity and provider data management are sold separately. The gap between them is where referrals leak, quality suffers, and claims are rejected. Gaine resolves both — and the relationship between them.
For provider organizations: Gaine HDMP, an operational health data management platform, resolves providers, patients, locations, networks and the relationships between them across the systems you run now, then delivers reconciled change to the systems that need to act on it.
Where this stops
What Gaine is not.
- Not your credentialing system. Credentialing stays the verified source for what it verifies. Gaine treats it as one source, and keeps its results aligned with everything else.
- Not your provider directory. Gaine provides the validated data reconciled with rosters and credentialing for your online directory.
- Not your decision maker. Conflicts where both values are defensible still need your decision. Gaine makes them visible, actionable and auditable.
One roster, one month
A physician leaves. Their patients don’t know yet.
A physician organization manages a provider network for several health plans. Each month, delegated medical groups send it their rosters, and it sends a roster to every plan.
Without Gaine HDMP
- Day 1
A delegated medical group sends its monthly roster. Names arrive as “Last, First” in one field, with no NPI and no license.
- Day 2
Without a reliable way to link the roster to the provider master file, the roster must be reviewed manually, as it is every month.
- Day 12
The manual review is still not complete, so the roster is blindly sent to the health plan to meet the contractual commitment.
- Day 20
A member assigned to a physician on the roster, but the physician has left the group, now creates an out-of-network claim.
OutcomeProvider network reporting requirements are impossible to fulfill in a manual process, thus leading to billing disputes.
The same events, with Gaine HDMP underneath
- Day 1
Client: Delegated roster
The group’s file lands by secure file transfer, as it does today. Nothing changes for the group.
Gaine HDMP:Roster to HDMP
Each provider is matched to the provider master by name, address and reference data. Missing NPIs and licenses are added from NPPES and the state licensing board.
No client activity
Gaine HDMP:Gaine HDMP internal
Providers already in the master match automatically. Those that don’t are flagged, together with the members assigned to them.
- Day 2
Client: Provider data team
The team reviews only the flagged providers, not the whole file, and confirms which have left.
Gaine HDMP:HDMP to Stewarding queue
Each flagged provider arrives with the members assigned to them and where each value came from.
- Day 3
Client: Network team
Reassigns the 110 members to an active physician at the same location, in its own system.
Gaine HDMP:Network team to HDMP to Health plan rosters
The next roster to each plan carries the corrected assignments. The referral system is sent the same change.
OutcomeThe roster each plan receives matches the providers who are actually there.
Illustrative. Each system connects the way it allows, so how far each one aligns differs.
One gap, four symptoms
Four teams, one problem.
Referrals, rosters, onboarding and claims each fail for the same reason: the provider record and the patients attached to it disagree from one system to the next.
02 / Rosters
Send every health plan a roster from one provider record.
Less manual review of delegated rosters, fewer roster rejections, and directory requirements met.
Used for
- Delegated roster intake
- Health plan roster production
- NPPES and state license enrichment
- Directory data quality
03 / Onboarding
Move a provider from credentialed to contracted to schedulable.
Shorter time from credentialing approval to a provider who can be scheduled and billed.
Used for
- Credentialing as a verified source
- Contracting and network participation
- Taxonomy and specialty alignment
- Onboarding and terminations
04 / Claims
Stop provider data from failing claims.
Fewer denials and claims edits caused by provider, location and taxonomy mismatches.
Used for
- Billing organization alignment
- Service location matching
- Taxonomy code alignment
- Payer–provider data exchange
Proof
Delegated rosters, matched automatically.
A physician-services organization managing roughly 10,000 providers and 50+ health plan rosters a month. None of its delegated groups’ rosters matched its provider master on provider name, so every file was reviewed by hand, every month.
0%Raw match on provider name
In all three rosters. Two carried no NPI or license at all.
82%Of providers matched automatically
Every provider already in the master, with no manual matching.
18%Of providers flagged for review
Not in the master. Missing identifiers were added from NPPES and the state board.
17%Of one group’s members assigned to those providers
Patients the organization could now reassign.
Measured on the organization’s own files. Clients are not named, due to confidentiality agreements.
IDC MarketScape: U.S. Healthcare Data Platform for Providers 2024–2025Major Player
Twenty owners, one record
Gaine is an AND, not an OR.
Credentialing, the EHR, scheduling, HR, directories, referrals, claims and every delegated group own part of the answer. They keep their systems. Gaine keeps them aligned.
Your existing EMPI or master data management
stays the master of identity. Gaine takes its identifiers and masters the data around them.
Your operational systems
keep running the work, and each team continues to make independent decisions on what updates to accept.
Your enterprise data warehouse or lakehouse
keeps the analysis. Gaine publishes governed records to it, one way, as they change.
Questions
Common questions from provider organizations.
Does Gaine replace our credentialing system?
No. Credentialing stays the verified source for what it verifies. Gaine treats it as one source among several and keeps its results aligned with rosters, directories, referrals and claims.
Does Gaine write into our EHR?
No, you control updates to your EHR. Gaine reads from it, and sends reconciled change files that your team applies through its own change control.
What does Gaine do with delegated rosters?
Each provider on a delegated group’s roster is matched to your provider master, missing identifiers are added from NPPES and the state licensing board, and providers who are not in the master are flagged with the members assigned to them.
Who resolves a conflict between two teams?
You do. Conflicts where both values are defensible still need your decision. Gaine makes them visible, actionable and auditable.