Provider Data Online Database

Clean up your data

Bad data costs health plans millions of dollars each year in unnecessary expenses. In contrast, accurate data can increase your claims auto-adjudication rates, prevent fraudulent claims from being paid and Increase your plan's coverage and provider density.

By leveraging the Optum™ Provider Data Online Database, health plan administrators can cost-effectively and continuously clean, correct and augment their own provider data. Now you can lower costs and drive efficiencies in claims processing, mailings, network management and other areas, without a large IT or call center effort. With the power of more than 600 sources, provider office verified data, and a host of mission-critical data elements; you can quickly make more accurate business decisions that directly benefit your organization.

Proprietary database

Provider Data Online Database uses a unique data sourcing model and provider outreach data verification program. This provides unparalleled provider coverage, data fills and accuracy. Exclusive Optum relationships provide access to rich repositories of health care provider information. This, combined with the data Optum aggregates directly from nearly every federal and state medical licensing and enumeration agency, allow Optum to deliver some of the industry’s most complete and reliable data.

Provider authentication and recruiting

Provider Data Online Database eliminates time lag for Health plans. Research the existence and credentials of a particular provider. Create a list of providers to fast-track online provider enrollment applications. Expedite claims adjudication for out-of-network providers. Simply get things done faster.

In addition, organizations can use Provider Data Online Database to identify providers that match a desired profile. For example, health plans that need to expand or augment their network use this database to find physicians affiliated with a particular hospital in a geographic area, and hospitals use it to recruit physicians with specialties that they need to complete their service offerings.

Data augmentation and confirmation

If your organization is missing data about a particular provider, this sophisticated lookup tool allows you to check your records against the Optum database, and provides the missing data to transfer into your in-house database. For example, if you have the physician’s name and DEA, Provider Data Online Database can obtain the NPI. In addition, you can use Provider Data Online Database to check the validity of data currently in your database to confirm practice location prior to a site visit.

Fraud investigation

In an effort to mitigate health care fraud, Provider Data Online Database can be used to research status on provider sanctions and deceased providers. You can also verify valid licenses for particular providers.

Provider data is a critical asset used throughout your organization for a variety of activities and applications. Chances are, multiple departments access and use the same provider data for different purposes. You may even support several databases to serve these varying needs. We can help you clean, standardize, and correct your data throughout your enterprise to improve efficiency. Optum Provider Data Online Database is a fast, reliable and inexpensive way to access accurate provider data immediately.

Organizations use Provider Data Online Database to:
  • Authenticate a provider’s credentials
  • Create ad hoc reports for special applications or projects
  • Run projects where each provider data use draws from different provider or element sets

  • Two provider search modalities: personal identifier search and general criteria search
  • Search results can be output as a printable report or in a variety of data file formats: MS Excel, MS Access or text files
  • Users can save search criteria prior to launching a search
  • Access the provider data you need instantly

Personal identifier search elements:
  • DEA number
  • Deceased
  • Geography
  • Hospital Affiliation
  • Optum Provider ID
  • License Data
  • Medical Degree/Certification
  • Medical Education
  • National Provider Identifier (NPI)
  • Personal Demographics
  • Phone/Fax number
  • Sanction Data
  • Social Security number
  • Specialty
  • State License Number
  • Tax ID number
  • UPIN