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Directories

The Directory solution enables health plans to increase the accuracy and timeliness of their provider directories. It automates the creation and maintenance of provider directories. It assists health plans in becoming more efficient, as well as moving closer to achieving NCQA compliance.

Business Challenges:

• Regulatory pressure to produce timely and accurate directories
• Difficulty in assimilating provider information from multiple sources
• Timeliness of updates to provider demographics, quality ratings and other characteristics
• Member and provider abrasion caused by directory inaccuracy
• Increasing complexity of provider information used by directories

Key Features:

• Dynamic creation of custom directories (e.g., network/product, employer specific, etc.)
• Data cleansing and enhancement through integration with leading external data providers
• Workflow-driven data capture from multiple data sources (e.g., internal systems, online provider portal, external data sets, etc.)
• Rules-driven inclusion and exclusion of providers into directories
• Rules-driven ordering of search results to enable steerage
• Robust and flexible information model for directory data storage and maintenance

Key Benefits:

• Reduces the cost of directory administration
• Improves the timeliness and accuracy of directories
• Improves the steerage of the member/patient base
• Enhances the member experience in their engagement with a health plan