The data that drives healthcare is growing at an exponential rate, and a robust, reliable provider data management (PDM) process is essential to keeping it accurate. Incorrect, out-of-date or inconsistent provider information has been shown to negatively impact a variety of processes within healthcare organizations. This includes claims processing, provider directory accuracy, credentialing, patient access, and self-scheduling portals, just to name a few.

The PDM process is challenging for healthcare because of its size, complexity and the lack of consistent quality standards across the industry. However, implementing PDM processes with automation is critical for successful operations and business transformation.

Inaccurate provider data leads to frustrated customers and slow-downs in internal processes. These include incorrect billing or denied claims due to inaccurate taxonomy and coding, delays in getting results or notes sent to the correct provider, or delays in scheduling an appointment because of incomplete information.

The most important element of a successful PDM solution is the ability to continuously update and scale the database as new information becomes available. This requires a technology platform that is scalable, easy to integrate with other technical systems, and can support a wide range of data sources. The most effective platforms use a cloud enterprise data warehouse or data marts to simplify integration and aggregation of provider data from multiple technical platforms, including EHRs, provider directories, registries, and marketing solutions. The intelligent gateway in these platforms monitors billions of transactions, identifies differences between what is submitted by the provider and what is on file with the health plan, and then automatically sends updates to the appropriate system.