Lean Provider Administration

Lean Provider Administration

Lean Provider Administration (LPA) enables plans to achieve administrative cost leadership through comprehensive provider data governance and automation of core provider processes. Core processes streamlined by LPA include recruiting, credentialing, provider data maintenance and provider feed management. It incorporates a service-oriented provider information repository, configurable workflows and flexible integration support.

Business Challenges

• Disparate/fragmented provider information systems resulting in a high cost of change
• Poor provider data quality disrupting claims payment and new product/care initiatives
• Response to business changes is impaired by siloed, paper intensive processes
• Difficulty in generating accurate provider profiles for network analysis and segmentation
• Limited timely visibility into provider operational bottlenecks
• Difficulty in electronic exchange of data with downstream systems and trading partners

Key Features

• Provider source of truth supporting all LOBs, network, care and payment models
• Provider recruiting and enrollment workflows
• Provider credentialing workflows
• Provider data maintenance workflows
• Provider data integration and exchange
• Provider identity management
• Clinical data integration

Key Benefits

• Administrative cost reduction across core provider operations
• Improved claims payment accuracy enabled by provider data quality
• Reduced data entry through integration with trading partners
• Reduced redundant data entry through consolidation
• Lower IT Total Cost of Ownership (TCO) for provider systems
• Flexibility to rapidly implement new provider initiatives (e.g., PCMH, ACO, Quality Programs)
• Increase in provider satisfaction through decreased cycle times

 

Solution(s)

Provider Recruiting
Credentialing
Provider Information Management
Identity Management
Information Exchange
Clinical Data Integration