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MONITORING INTELLIGENCE ACROSS THE PAYER ECOSYSTEM


YOUR GUIDE TO BETTER DATA, BETTER EFFICIENCIES FOR MANAGING PROVIDER NETWORKS


ACROSS MOST PAYER ORGANIZATIONS, PROVIDER NETWORK DATA IS GATHERED AND UTILIZED
IN SILOS.

So to start, help us learn a little more about you by answering a few questions
below.

YOUR ROLE

OTHER PARTICIPANTS








WHAT IS YOUR ROLE?





Compliance

Provider Operations

Credentialing

Payment Integrity

Special Investigations Unit

Other




DID YOU KNOW?

Workflow inefficiencies and data inaccuracies across departments are likely
costing your organization millions of dollars each year.


PROVIDER DATA UPDATES ARE MADE AT VARYING TIME INTERVALS.






PROVIDER ELIGIBILITY AND MONITORING DATA IS PULLED FROM DISPARATE SOURCES AT
BOTH THE FEDERAL AND STATE LEVELS.


PROVIDER NETWORK DATA IS MANUALLY MANAGED AND PRONE TO HUMAN ERROR.

BETTER MONITORING INTELLIGENCE BREAKS DOWN DEPARTMENTAL SILOS


THE MANY ROLES OF PROVIDER NETWORK DATA WITHIN YOUR ECOSYSTEM

The tremendous costs of healthcare fraud, waste, and abuse (FWA) is an evergreen
topic for the US healthcare system. Identifying, investigating, and ending
fraudulent and abusive schemes within provider networks demand significant
resources. The success of these efforts depend on data speed, accuracy, and
cross-functional collaboration across your payer ecosystem. Since
provider-committed fraud typically manifests as ongoing cycles of false or
upcoded claims and kickbacks, speed-to-action protects revenue.

Payment Integrity





Compliance





Credentialing





Provider Operations





Value-Based Networks





Special Investigations Unit




COMPLIANCE



Tasked with ensuring organizational adherence to federal and state regulations
across all primary sources and staying audit ready in a shifting regulatory
environment. Often asks: Are we meeting the internal and external standards for
oversight and protecting ourselves from penalties and damages? Do we have the
readily available documentation to prove this?



8.7m+

people / entities monitored ongoing


SILOED WORKFLOWS ARE NO LONGER GOOD ENOUGH.

4,000+

disciplinary action sources

Centralized provider eligibility and monitoring intelligence ensures data
insights exist where stakeholders need it most - and empowers efficient
communication across teams. At ProviderTrust, we deliver one powerful platform
with a flexible API that breaks down silos, improving quality of care for your
members, and reducing both medical and administrative spends for your
organization. With more than a decade of experience in exclusion monitoring and
license verification, our one platform approach connects vital intelligence to
the moments and workflows you need it most.



600+

individual state licensing boards

830k+

licenses monitored continuously




WE MONITOR YOUR:

Par and Non-Par Providers Licensed Employees and Physicians Non-Licensed
Employees and Staff Vendors, Subcontractors, and Physician-Owned Entities
Contingents, Brokers, and Outside Counsel







State Sanction Lists OIG LEIE Exclusion Lists State Licensing Boards Federal and
State Enabling Sources







ACROSS ALL:


OUR DIFFERENTIATORS

OUR WORKFLOW DESIGNS

We serve the entirety of the healthcare ecosystem through population-specific
workflow design, including Networks like yours.

EXACT-MATCH RESULTS

We guarantee exact-match results via automation and real, human verifiers.

OUR COMPLIANCE INTELLIGENCE

We enrich primary source data for always-accurate compliance monitoring
intelligence.





BREAKING DOWN SILOS THROUGH A SHARED COMMITMENT OF PROVIDER NETWORK INTEGRITY –
THAT’S THE POWER OF BETTER REIMAGINED™.



Let's Do Better Together


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