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Provider Information Management
Portico’s Provider Information Management (PIM) solution automates provider management workflows and significantly improves data quality and process efficiency. Portico enables a 360° view of a health plan’s providers. Portico’s PIM solution improves data reliability through the consistent use of business rules. It also brokers the electronic exchange of provider data with external and internal systems. The result is decreased provider data administration costs and increased quality.
Key features:
- Single source of truth for provider information
- Configurable information model that supports 360° view of the provider relationship
- Flexible network hierarchy definition and maintenance (line of business, product, tiered networks and specialty networks)
- Support for all provider types (practitioners, facilities, ancillaries, dental, behavioral, etc.)
- Guided data entry and maintenance wizards for adding, changing, and terminating providers
- Rules driven data integrity and validation
- Comprehensive affiliation tracking and management
- Robust provider search and inquiry
- Automated bulk updates
- Built-in provider ID crosswalk (NPIs, legacy IDs, UPINs, etc.)
- Configurable provider performance management
- Reconciliation across multiple external data sources (e.g. CAQH, Third-party Networks, etc.)
- Real-time and batch integration across enterprise systems (e.g. claims, medical management, etc.)
Key benefits:
- Increased provider data reliability and accessibility across the enterprise
- Increased auto adjudication and claims accuracy
- Decreased time to market for provider initiatives
- Decreased cost of provider data maintenance
- Elimination of redundant data entry and manual handoffs
- Reduced manual intervention of provider data exchange
- Decreased staff training costs
