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Provider Information Management

McKesson’s Provider Information Management (PIM) solution enables health plans to establish an enterprise provider source of truth to reduce provider administration and IT costs. Automated workflows guide users through provider maintenance tasks, and rules enforce data integrity and accuracy.  With flexible integration options, electronic exchange with downstream systems is enabled to eliminate manual hand offs.

Business Challenges:

• Claims over/under payment due to poor provider data quality
• Inflexibility and high cost to support new care and payment models as well as other provider initiatives
• Fragmented provider systems and processes resulting in sub-optimal provider service experience
• Member and provider abrasion caused by directory inaccuracy
• Redundant data entry and quality checks resulting from disparate/overlapping provider systems
• Fragmented/siloed system provider infrastructure increase IT costs through redundant systems
• Manual hand offs driven by disconnected provider systems
• Difficulty in obtaining an accurate and timely view into provider relationship status with the plan
• Timeliness of updates to provider demographics, quality ratings and other characteristics

Key Features:

• Extensible Provider Source of Truth that supports all lines of business, care models and payment arrangements
• Support for all provider types: practitioners, facilities, ancillaries, dental, behavioral, etc.
• Flexible network hierarchy definition and maintenance: line of business, product, tiered networks and specialty networks
• Configurable guided data entry and maintenance wizards for adding, changing, and terminating providers
• 360° provider view including demographics, affiliations, networks, contracts, credentialing, communications, practice profile, quality summary, etc.
• Centralized provider data rules for comprehensive data governance
• 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.)
• Provider ID crosswalk to enable flexible provider enumeration
• Robust field level auditing capabilities for increased accountability
• Flexible provider search capabilities for rapid retrieval of provider records

Key Benefits:

• Decreased claim mis-payments and directory errors
• Administrative cost reduction for provider file maintenance
• Increased speed to market of provider network initiatives
• Increased provider data governance
• Enhanced downstream system integration
• Elimination of redundant data entry and manual hand offs
• End-to-end process visibility drives elimination of bottlenecks
• Reduced manual intervention of provider data exchange
• Decreased staff training costs