Maintaining Accurate Provider Information Shouldn’t Be So Hard

The one hiccup that can derail any automated insurance claim and what you can do to solve it

How many times have you gone to run claim auto-adjudication and see the same error – “Provider not found”. Maybe it’s a small mistake like a missed keystroke in data entry, or maybe it’s a much bigger issue and the data has changed significantly. Either way, with that error message, begins the never-ending odyssey to track down a provider’s current information.

Maintaining your provider database can be a challenge for many reasons. 

  • Providers are often on the move and do not update their information in a timely manner
  • Tracking provider data changes is time intensive and is never the highest priority on the ‘to do’ list
  • Options and resources for how to update Provider Data can be complex. The personnel maintaining the databases may not have the technological know-how to keep up
  • The right balance of Technological know-how and human resources can make all the difference. Data, often not standardized, meaning programming may overlook an error that human eyes would be able to fix

Staying on top of all of these details makes all of the difference in how quickly your team can assess and process incoming claims – but it can be a titanic task.

Don’t have the bandwidth? JMS can be a flexible resource for your team. Our associates are former TPA employees who can meet you where you are. We know that in the world of cluttered provider data, there is no such thing as a one-size-fits-all solution. By outsourcing your most frustrating challenges, you allow your entire claims department to move more efficiently and effectively. 

Stop allowing provider errors to slow you down – you and your clients deserve a process that works. Reach out to set up a preliminary call to see how JMS can best serve you.